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1.
Medicine (Baltimore) ; 99(29): e20799, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702823

RESUMO

Sessile serrated adenomas (SSAs) are precursors of colorectal cancer (CRC). However, there are limited data on detection rates of this premalignant lesion during colonoscopy surveillance in patients with a history of left side colonic resection for cancer. We aimed to identify the incidence and risk factors of SSAs in post-left side colectomy patients.We retrospectively reviewed the medical records of patients who had undergone left side colectomy for colon and rectal cancer between September 2009 and September 2016 and had at least 1 follow-up colonoscopy. Patient baseline characteristics, SSA diagnoses and characteristics, and colonoscopy information were collected.In total, 539 patients were enrolled. At the first follow-up (mean duration 11.5 months), 98 SSAs were identified (22.2%). At the second follow-up (mean duration 25.8 months), 51 SSAs were identified in 212 patients (24.0%). Multivariate analysis showed that alcohol intake (hazard ratio [HR] 1.524; 95% confidence interval [CI] .963-2.411, P = .041), excellent bowel preparation (HR 2.081; 95% CI 1.214-3.567, P = .049), and use of a transparent cap (HR 1.702; 95% CI 1.060-2.735, P = .013) were associated with higher SSA incidence in the first surveillance colonoscopy, while body mass index (BMI) ≥ 25.0 (HR 1.602; 95% CI 1.060-2.836) was associated with a significantly increased risk of SSAs in the second surveillance.Considering the endoscopic appearance of SSAs, adequate bowel preparation and use of transparent caps during postoperative surveillance colonoscopy can increase the diagnosis rate. Modification of alcohol intake and BMI may reduce the incidence of SSAs in left side colon cancer patients.


Assuntos
Adenoma/epidemiologia , Adenoma/patologia , Neoplasias Colorretais/cirurgia , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Índice de Massa Corporal , Catárticos/efeitos adversos , Colectomia/efeitos adversos , Colonoscopia/métodos , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(6): 578-583, 2020 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-32521978

RESUMO

Objective: To understand the current practice of preoperative bowel preparation in elective colorectal surgery in China. Methods: A cross-sectional questionnaire survey was conducted through wechat. The content of the questionnaire survey included professional title of the participants, the hospital class, dietary preparation and protocol, oral laxatives and specific types, oral antibiotics, gastric intubation, and mechanical enema before elective colorectal surgery. A stratified analysis based on hospital class was conducted to understand their current practice of preoperative bowel preparation in elective colorectal surgery. Result: A total of 600 questionnaires were issued, and 516 (86.00%) questionnaires of participants from different hospitals, engaged in colorectal surgery or general surgeons were recovered, of which 366 were from tertiary hospitals (70.93%) and 150 from secondary hospitals (29.07%). For diet preparation, the proportions of right hemicolic, left hemicolic and rectal surgery were 81.59% (421/516), 84.88% (438/516) and 84.88% (438/516) respectively. The average time of preoperative dietary preparation was 2.03 days. The study showed that 85.85% (443/516) of surgeons chose oral laxatives for bowel preparation in all colorectal surgery, while only 4.26% (22/516) of surgeons did not choose oral laxatives. For mechanical enema, the proportions of right hemicolic, left hemicolic and rectal surgery were 19.19% (99/516), 30.04% (155/516) and 32.75% (169/516) respectively. Preoperative oral antibiotics was used by 34.69% (179/516) of the respondents. 94.38% (487/516) of participants were satisfied with bowel preparation, and 55.43% (286/516) of participants believed that preoperative bowel preparation was well tolerated. In terms of preoperative oral laxatives, there was no statistically significant difference between different levels of hospitals [secondary hospitals vs. tertiary hospitals: 90.00% (135/150) vs. 84.15% (308/366), χ(2)=2.995, P=0.084]. Compared with the tertiary hospitals, the surgeons in the secondary hospitals accounted for higher proportions in diet preparation [87.33% (131/150) vs. 76.78% (281/366), χ(2)=7.369, P=0.007], gastric intubation [54.00% (81/150) vs. 36.33% (133/366), χ(2)=13.672, P<0.001], preoperative oral antibiotics [58.67% (88/150) vs. 24.86% (91/366), χ(2)=12.259, P<0.001] and enema [28.67% (43/150) vs. 15.30% (56/366), χ(2)=53.661, P<0.001]. Conclusion: Although the preoperative bowel preparation practice in elective colorectal surgery for most of surgeons in China is basically the same as the current international protocol, the proportions of mechanical enema and gastric intubation before surgery are still relatively high.


Assuntos
Colectomia/métodos , Enema/métodos , Protectomia/métodos , Prática Profissional/normas , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/uso terapêutico , Catárticos/administração & dosagem , China , Colectomia/efeitos adversos , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Pesquisas sobre Serviços de Saúde , Humanos , Intubação Gastrointestinal , Cuidados Pré-Operatórios/métodos , Protectomia/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(Z1): 48-55, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32594726

RESUMO

Objective: To investigate the effect of intestinal preparation on the efficacy and complications of fecal microbiota transplantation (FMT). Methods: A retrospective cohort study was performed. Clinical and follow-up data of 1501 patients who received FMT in the department of Colorectal Disease Specialty, Intestinal Microecology Diagnosis and Treatment Center, the Tenth People's Hospital, Tongji University from February 2018 to June 2019 were collected retrospectively. According to the intestinal preparation before FMT treatment, patients were divided into non-intestinal preparation group (n=216), antibiotic pretreatment group (n=383), intestinal cleansing group (n=267), and antibiotic combined with intestinal cleansing group (n=635). The adverse reactions after FMT treatment and the effective rates at 4-week and 8-week after treatment among the groups were compared. Patients, who repeated FMT treatment in the 3rd month and the 6th month due to reduced efficacy or ineffectiveness were divided into two subgroups: without intestinal preparation group and with intestinal preparation group. The effective rates of the two subgroups were compared. Results: Of the 1501 cases, 588 were male and 913 were female with mean age of (43.3±13.7) years and body mass index of (20.2±2.1) kg/m(2). Transplantation course was (3.3±1.7) weeks. The underlying diseases mainly included constipation (n=564), Crohn's disease (n=157), ulcerative colitis (n=142), irritable bowel syndrome (n=158), recurrent C. difficile infection (CDI) (n=106), autism (n=84), radiation intestinal injury (n=133), radiation enteritis (n=133), and non-CDI chronic diarrhea (n=60); the remaining cases (n=155). Baseline data among the 4 groups were not significantly different (all P>0.05). The overall morbidity of complication was 31.1% (467/1501), including 41 cases of vomiting (2.7%), 91 of nausea (6.1%), 49 of diarrhea (3.3%), 41 of abdominal pain (2.7%), 79 of bloating (5.3%), 72 of throat pain (4.8%), 38 of dizziness (2.5%), 51 of fever (3.4%), 3 of pulmonary infection (0.2%) and 2 of intestinal infection (0.1%). The above symptoms disappeared after symptomatic treatment. There was no statistically significant difference in the incidence of adverse reactions among the 4 groups (P>0.05). After 4-week of FMT treatment, the overall effective rate was 63.5% (902/1420); the effective rate of non-intestinal preparation group, antibiotic pretreatment group, intestinal cleaning group, and antibiotic combined with intestinal cleansing groupwas 57.6% (114/198), 64.2% (231/360), 60.2% (154/265) and 66.5% (403/606), respectively, with no statistically significant difference (χ(2)=6.659, P=0.084). After 8-week of FMT treatment, the overall effective rate was 61.3% (729/1293); the effective rate of non-intestinal preparation group, antibiotic pretreatment group, intestinal cleaning group, and antibiotic combined with intestinal cleansing group was 54.0% (88/163), 62.2% (202/325), 57.4% (132/230) and 64.4% (370/575), respectively, with no statistically significant difference (χ(2)=13.620, P=0.003). The effective rates of antibiotic combined with intestinal cleansing group and antibiotic pretreatment group were obviously higher than that of non-intestinal preparation group (χ(2)=5.789, P=0.016; χ(2)=10.117, P=0.001). Subgroup analysis showed that in the third month, the effective rate at 4-week after treatment was 60.1% (184/306) in the without intestinal preparation group and 61.5% (115/187) in the with intestinal preparation group, whose difference was not significant (χ(2)=0.091, P=0.763); however, in the sixth month, the effective rate at 4-week after treatment was 51.4% (89/173) in the without intestinal preparation group and 61.2% (161/263) in the with intestinal preparationgroup, whose difference was significant (χ(2)=4.229, P=0.040). Conclusions: FMT treatment is safe and effective. The combination of antibiotics and intestinal cleaning can improve overall efficacy of FMT. For patients who need repeated FMT treatment, the combination of antibiotics and intestinal cleaning program within 3 months has no significant effect on the effective rate, but in the sixth month, combinedpreparation is necessary.


Assuntos
Transtorno Autístico/terapia , Transplante de Microbiota Fecal/métodos , Enteropatias/terapia , Adulto , Antibacterianos/administração & dosagem , Catárticos/administração & dosagem , Enema , Fezes/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
4.
PLoS One ; 15(5): e0233346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437378

RESUMO

Bowel preparation with low-residue diet (LRD) has resulted in higher patient satisfaction and similar polyp detection rates compared to conventional clear liquid diet. However, there is limited experience with LRD in veterans, in whom conditions associated with poor bowel preparation are more prevalent than the general population. To examine risk factors associated with inadequate bowel preparation, we conducted a chart review of outpatient colonoscopies at the Manhattan VA Medical Center from February 2017 to April 2018. To examine patient satisfaction and compliance, we administered an anonymous questionnaire to patients undergoing outpatient colonoscopy from March to August 2018. Patients assessed by chart review (n = 660) were 92% male with a mean age of 64 years. An adequate Boston Bowel Preparation Scale score ≥2 in each colonic segment was achieved in 94% of procedures. Higher BMI, diabetes, prior inadequate bowel preparation, bowel preparation duration of two days, and opioid use were associated with inadequate bowel preparation on univariable analysis. On multiple logistic regression, only higher BMI remained a predictor, with every one-unit increase associated with a 6% increased odds of poor bowel preparation. Questionnaire responses showed 84% of patients were willing to repeat LRD bowel preparation, 85% found the process easy or acceptable, and 78% reported full adherence to LRD. These findings demonstrate that bowel preparation quality, patient satisfaction, and compliance were all high among veterans using LRD.


Assuntos
Colonoscopia/métodos , Dieta , Cooperação do Paciente , Satisfação do Paciente , Idoso , Assistência Ambulatorial , Catárticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Fatores de Risco , Inquéritos e Questionários , Estados Unidos , United States Department of Veterans Affairs , Veteranos
5.
Curr Gastroenterol Rep ; 22(6): 28, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32377915

RESUMO

PURPOSE OF THIS REVIEW: Colorectal cancer is the third most common cancer in the USA. Colonoscopy is considered the gold standard for colorectal cancer screening and can offer both diagnosis and therapy. The bowel preparation remains a significant barrier for patients who need to undergo colonoscopy and is often cited as the most dreaded aspect of the colonoscopy process. Inadequate bowel preparations still occur in 10-25% of colonoscopies, and this in turn can lead to increased procedural times, lower cecal intubation rates, and shorter interval between colonoscopies. From a quality standpoint, it is imperative that we do what we can to decrease the rate of inadequate bowel preparations. This review will focus on recent data regarding bowel preparation and offers a glimpse into what may be coming in the future. RECENT FINDINGS: Recent advances in the field have been made to improve tolerability of bowel preparations and allow for more adequate colonoscopies. Newer, lower volume, flavored preparations, the use of adjuncts, and using split-dose preparations all can help with tolerability, compliance, and, in turn, preparation quality. Edible bowel preparations may become available in the near future. Early data on the use of artificial intelligence for assessment of preparation quality has been promising. Additionally, utilization of smartphone technology for education prior to the bowel preparation has also been shown to improve the adequacy of bowel preparations. CONCLUSIONS: Ongoing efforts to improve the tolerability and palatability of colonoscopy bowel preparations are important from a quality improvement standpoint to ensure the adequacy of colonoscopy. Incorporating patient-specific factors and comorbidities is also an essential aspect of improving the quality of bowel preparation. Leveraging technology to better communicate with and educate patients on the bowel preparation process is likely to play a larger role in the coming years.


Assuntos
Catárticos/administração & dosagem , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Cuidados Pré-Operatórios/normas , Inteligência Artificial , Colonoscopia/tendências , Dieta , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/tendências , Humanos , Cooperação do Paciente , Educação de Pacientes como Assunto , Cuidados Pré-Operatórios/tendências , Melhoria de Qualidade , Smartphone
6.
PLoS One ; 15(5): e0233490, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437402

RESUMO

BACKGROUND: Colonoscopy is a valuable screening tool for colorectal cancer. However, patients experience anxiety when faced with attending a first colonoscopy, and negative attitudes may contribute to non-attendance. Few studies in Europe have explored these attitudes, despite increasing colorectal cancer incidence. STUDY AIM: We conducted an online survey of the public in five European Union countries (France, Germany, Italy, Spain, and the UK), with the aim of understanding public knowledge of, perceptions of, and attitudes towards, colonoscopy and bowel preparation, amongst colonoscopy-naïve respondents. Attitudes towards colonoscopy were also gathered from colonoscopy-experienced patients. METHODS: Survey answers were gathered from 2,500 colonoscopy-naïve respondents and 500 colonoscopy-experienced patients, divided equally between countries. RESULTS: Across Europe, 72% of colonoscopy-naïve respondents showed receptiveness to colonoscopy if advised by their doctor to receive one, but only 45% understood its use to prevent colorectal cancer. Forty-three percent of colonoscopy-experienced respondents would still be embarrassed about having another colonoscopy, although 59% said that the experience had been better than expected. Colonoscopy-experienced respondents had greater aversion to bowel preparation than colonoscopy-naïve respondents (47% vs 26%), and 67% of colonoscopy-naïve respondents thought that only 1 litre of bowel preparation or less is required. Italians and the Spanish wanted more information than on average in Europe, while Germans had more realistic expectations of bowel preparation. DISCUSSION: There are perceptual gaps amongst the public around the purpose of colonoscopies, the subjective experience of the colonoscopy procedure, and the quantity of bowel preparation needed. These concerns could be mitigated by better education and using lower-volume bowel preparation techniques. CONCLUSION: Europeans would have a colonoscopy, but its preventive medical purpose is poorly understood and there are misconceptions around the process. Further education about the procedure, its benefits and bowel preparation is vital to improve understanding and compliance.


Assuntos
Colonoscopia , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Catárticos/uso terapêutico , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Am J Obstet Gynecol ; 223(2): 231.e1-231.e12, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32112733

RESUMO

BACKGROUND: Literature on the use of bowel preparation in gynecologic surgery is scarce and limited to minimally invasive gynecologic surgery. The decision on the use of bowel preparation before benign or malignant hysterectomies is mostly driven by extrapolating data from the colorectal literature. OBJECTIVE: Bowel preparation is a controversial element within enhanced recovery protocols, and literature investigating its efficacy in gynecologic surgery is scarce. Our aim was to determine if mechanical bowel preparation alone, oral antibiotics alone, or a combination are associated with decreased rates of surgical site infections or anastomotic leaks compared to no bowel preparation following benign or malignant hysterectomy. STUDY DESIGN: We identified women who underwent hysterectomy between January 2006 and July 2017 using OptumLabs, a large US commercial health plan database. Inverse propensity score weighting was used separately for benign and malignant groups to balance baseline characteristics. Primary outcomes of 30-day surgical site infection, anastomotic leaks, and major morbidity were assessed using multivariate logistic regression that adjusted for race, census region, household income, diabetes, and other unbalanced variables following propensity score weighting. RESULTS: A total of 224,687 hysterectomies (benign, 186,148; malignant, 38,539) were identified. Median age was 45 years for the benign and 54 years for the malignant cohort. Surgical approach was as follows: benign: laparoscopic/robotic, 27.2%; laparotomy, 32.6%; vaginal, 40.2%; malignant: laparoscopic/robotic, 28.8%; laparotomy, 47.7%; vaginal, 23.5%. Bowel resection was performed in 0.4% of the benign and 2.8% of the malignant cohort. Type of bowel preparation was as follows: benign: none, 93.8%; mechanical bowel preparation only, 4.6%; oral antibiotics only, 1.1%; mechanical bowel preparation with oral antibiotics, 0.5%; malignant: none, 87.2%; mechanical bowel preparation only, 9.6%; oral antibiotics only, 1.8%; mechanical bowel preparation with oral antibiotics, 1.4%. Use of bowel preparation did not decrease rates of surgical site infections, anastomotic leaks, or major morbidity following benign or malignant hysterectomy. Among malignant abdominal hysterectomies, there was no difference in the rates of infectious morbidity between mechanical bowel preparation alone, oral antibiotics alone, or mechanical bowel preparation with oral antibiotics, compared to no preparation. CONCLUSION: Bowel preparation does not protect against surgical site infections or major morbidity following benign or malignant hysterectomy, regardless of surgical approach, and may be safely omitted.


Assuntos
Antibacterianos/uso terapêutico , Catárticos/uso terapêutico , Histerectomia/métodos , Cuidados Pré-Operatórios/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Doenças Uterinas/cirurgia , Neoplasias Uterinas/cirurgia , Administração Oral , Adulto , Fístula Anastomótica/epidemiologia , Feminino , Humanos , Histerectomia Vaginal/métodos , Íleus/epidemiologia , Laparoscopia/métodos , Laparotomia , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos
8.
Geriatr Gerontol Int ; 20(6): 559-563, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32207216

RESUMO

AIMS: Colon preparation is vital yet more difficult in elderly patients with severe lower gastrointestinal bleeding (LGIB). The aim of this study is to show the efficacy, safety and outcomes of unprepared polyethylene glycol (PEG)-flush retrograde colon cleansing in the diagnosis and treatment of elderly home care patients with LGIB. METHODS: A single-center study was performed between January 2014 and June 2018. Elderly home healthcare patients presenting with hematochezia were enrolled, and an unprepared retrograde bowel cleansing colonoscopy was performed within the first 8 h after admission to the emergency department. PEG solution (2 L) was added to the water jet tank, and jet pump injection was started from the left side of the colon to the right segment of the colon and ended up at the cecum. RESULTS: In total, 33 elderly patients presenting with hematochezia were evaluated. Mean inward and outward procedure times were 17.06 ± 4.92 (8-33 min) and 28.66 ± 6.88 (10-30 min), respectively. Most of the bleeding was localized in the right colon at 22 patients (66.3%). Endoscopic treatment was performed in 87.9% of patients. The average length of stay in hospital was 44.70 ± 42.81 (range 18.00-240.00 h). CONCLUSIONS: Immediate unprepared PEG-flush colonoscopy in elderly home care patients with acute LGIB is a safe and effective method, which detects bleeding sources and provides endoscopic therapy. With this procedure, the time of hospital stay is reduced. This approach may be used for the initial intervention in patients admitted to emergency departments or intensive care unit with severe acute LGIB. Geriatr Gerontol Int 2020; ••: ••-••.


Assuntos
Colonoscopia/métodos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Polietilenoglicóis/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Catárticos/administração & dosagem , Feminino , Hospitalização , Humanos , Masculino
9.
Medicine (Baltimore) ; 99(8): e19208, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080109

RESUMO

AIM: Adequate bowel preparation is essential to the quality of colonoscopy. We performed a meta-analysis to determine the efficacy and safety of the addition of lubiprostone to the bowel preparation process prior to colonoscopy. METHODS: Online databases, namely, PubMed, MEDLINE and Cochrane Library, were searched for randomized controlled trials that assessed the additive effect of lubiprostone on the quality of colon preparation in patients undergoing colonoscopy. Each included study was evaluated by the Jadad score to assess the quality of the study. The primary outcome was bowel preparation efficacy, defined as the proportion of patients with an excellent or poor preparation. The secondary outcomes included the length of the colonoscopy, polyp detection, and any adverse effects. RESULTS: In total, 5 articles published between 2008 and 2016 fulfilled the selection criteria. The addition of lubiprostone to the bowel cleansing process significantly increased the proportion of patients with an excellent preparation (risk ratio [RR] = 1.68, 95% confidence interval (CI): 1.40-2.02, P < .00001) but did not decrease the procedural time or increase the polyp detection rate (mean difference = -0.52, 95% CI: -3.74-2.69, P = .75; RR = 1.16, 95% CI: 0.96-1.42, P = .13, respectively). There was no significant difference in the proportion of patients with any adverse events. CONCLUSION: The addition of lubiprostone to the bowel preparation regimen prior to colonoscopy is effective and safe.


Assuntos
Colonoscopia/métodos , Lubiprostona/administração & dosagem , Catárticos , Quimioterapia Combinada , Humanos , Duração da Cirurgia , Polietilenoglicóis/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Medicine (Baltimore) ; 99(2): e18702, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914075

RESUMO

BACKGROUND/AIMS: Old age is a risk factor of suboptimal bowel preparation. This study aimed to evaluate the efficacy of mosapride citrate with a split dose of polyethylene glycol (PEG) plus ascorbic acid for bowel preparation in elderly patients (aged ≥65 years) before they underwent a colonoscopy. MATERIALS AND METHODS: This prospective investigator-blinded randomized study was conducted from November 2017 to October 2018. The patients were randomly divided into 2 groups, a mosapride group (mosapride citrate with a split-dose of PEG plus ascorbic acid) or a non-mosapride group (a split-dose of PEG plus ascorbic acid alone). Mosapride citrate 15 mg (Gastin CR) was administered once with each split-dose of the bowel preparation. The bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS). RESULTS: A total of 257 patients were finally included and analyzed in our study. The total BBPS score was significantly higher in the mosapride group than in the non-mosapride group (8.53 vs 8.24, P = .033). The BBPS scores of the right colon and mid-colon were 2.75 vs 2.61 (P = .044) and 2.89 vs 2.79 (P = .030), respectively. The rate of adequate bowel preparation (BBPS ≥ 6) was similar in both groups (98.4% vs 98.5%, P = .968), while the rate of excellent bowel preparation (BBPS = 9) was higher in the mosapride group than in the non-mosapride group (73.8% vs 61.1%, P = .029). The total incidence of adverse events during the administration of the bowel cleansing agent, particularly abdominal fullness, was lower in the mosapride group (11.9% vs 30.5%, P < .001). CONCLUSION: The administration of mosapride citrate with a split-dose of PEG plus ascorbic acid in elderly patients showed an increase in bowel preparation efficacy and reduced adverse events, particularly abdominal fullness, during the administration of a bowel cleansing agent.


Assuntos
Ácido Ascórbico/uso terapêutico , Benzamidas/uso terapêutico , Catárticos/uso terapêutico , Colonoscopia/métodos , Morfolinas/uso terapêutico , Polietilenoglicóis/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Ácido Ascórbico/administração & dosagem , Benzamidas/administração & dosagem , Benzamidas/efeitos adversos , Catárticos/administração & dosagem , Catárticos/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Morfolinas/administração & dosagem , Morfolinas/efeitos adversos , Cooperação do Paciente , Satisfação do Paciente , Polietilenoglicóis/administração & dosagem , Cuidados Pré-Operatórios , Estudos Prospectivos , Método Simples-Cego
11.
Rev Med Chil ; 147(8): 977-982, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31859961

RESUMO

BACKGROUND: A successful colonoscopy depends, among other factors, on a proper colon cleansing. This variable also affects the acceptance of the patient to carry out the study. AIM: To analyze the efficacy and tolerability of a low volume polyethylene glycol formulation (2 liters), compared to the conventional presentation of 4 liters. MATERIAL AND METHODS: Patients referred for a colonoscopy were randomly divided to receive either two or four liter of polyethylene glycol as bowel cleansing, which was assessed using the Boston score. Raters of the latter were blinded to the volume of polyethylene glycol that the patients used. RESULTS: Seventy-four patients participated in the study. Subjects who received a 4 liters preparation had an average Boston score of 7.78, versus 8.16 for patients who received a volume of 2 liters (p = 0.267). No significant differences in tolerability were observed between both groups. No significant differences in the efficacy and tolerability between a conventional or a reduced volume of polyethylene glycol solution for the preparation of a colonoscopy were observed. These findings may be especially important for subgroups of patients with difficulties for oral administration of fluids.


Assuntos
Catárticos/administração & dosagem , Colonoscopia/métodos , Polietilenoglicóis/administração & dosagem , Adulto , Idoso , Tolerância a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Inquéritos e Questionários
13.
BMJ Case Rep ; 12(10)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653623

RESUMO

​A 62-year-old woman presented to a rural Australian hospital for a planned admission to receive bowel preparation 1 day prior to an upper endoscopy and colonoscopy. This admission was complicated by seizures and reduced levels of consciousness in the setting of hyponatraemia secondary to bowel preparation. Given the limited resources in a remote/rural Australian hospital, transfer to a tertiary level hospital was required for review and management of this rare complication of bowel preparation.


Assuntos
Catárticos/efeitos adversos , Hiponatremia/induzido quimicamente , Convulsões/induzido quimicamente , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Colonoscopia , Feminino , Humanos , Hiponatremia/diagnóstico por imagem , Pessoa de Meia-Idade , Pneumonia Aspirativa/tratamento farmacológico , Solução Salina , Convulsões/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Ann Palliat Med ; 8(4): 476-482, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31594376

RESUMO

BACKGROUND: To explore the value of care bundles (CBs) in bowel preparation for colonoscopy in children. METHODS: Children who underwent electronic fiberoptic colonoscopy or enteroscopic surgery in our hospital from September 2016 to October 2017 were enrolled as the conventional nursing (CN) group and children who received such procedures from November 2017 to December 2018 were enrolled as the care bundle group. Polyethylene glycol electrolyte lavage solution (PEG-ELS) was used for bowel preparation in all children. The CBs included nurse education, risk evaluation of inadequate bowel preparation, education of children and families, and observation and assessment during preparation. The quality of bowel preparation, tolerance and safety, families' anxiety score, and degree of satisfaction with hospitalization were compared between these two groups. RESULTS: Eighty-two children were enrolled in this study, with 42 cases in the CB group and 40 cases in the CN group. Symptoms of distension, abdominal pain, vomiting, and fatigue, along with intragastric feeding, were compared between the two groups. An additional enema was performed in 2 cases in the CB group and in 12 cases in the CN group, demonstrating a significant difference between the groups. The Aronchick score and anxiety score of families were 1.24±0.85 vs. 2.35±1.76 (t=-3.477, P=0.001) and 3.28±0.85 vs. 5.45±1.78 (t=-3.473, P=0.001) in the CN group and CB group, respectively. The satisfaction rate was 97.62% vs. 85.00% (χ2=6.764, P<0.001). CONCLUSIONS: Implementation of the care bundles in the bowel preparation of children planning to receive colonoscopy can improve the quality of preparation and the satisfaction with hospitalization while alleviating the anxiety of patients and their families.


Assuntos
Catárticos/administração & dosagem , Colonoscopia/métodos , Pacotes de Assistência ao Paciente , Polietilenoglicóis/administração & dosagem , Administração Oral , Adolescente , Ansiedade/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Satisfação do Paciente , Fatores de Risco
15.
Acta Gastroenterol Belg ; 82(3): 407-415, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566329

RESUMO

OBJECTIVE: To assess the efficacy adjunction of oral simethicone to polyethylene glycol as bowel preparation agent on cecal intubation rate. METHODS: We searched EMBASE, PubMed and Cochrane library for randomized controlled trials regarding simeticone plus polyethylene glycol as oral drinking agents before gastroscopy,we used the soft RevMan5.3 to perform statistical analysis and stata12.0 for publication bias. RESULTS: 12 randomized trials that met the inclusion criteria were therefore pooled into a meta-analysis, which included a total of 5,112 patients. There were no significant differences on cecal intubation rate in two groups(RR=1.0,95%CI : 0.99-1.01, P=0.93) with moderate level of evidence;Subgroups analysis of 2LPEG+ Simethicone VS 2LPEG(RR =1.0, 95% CI : 0.98,1.01), 2LPEG+ Simethicone VS 4L PEG (RR=1.00, 95% CI : 0.98,1.02), PEG+ Simethicone with bisacodyl vs PEG (RR =1.00, 95% CI : 0.99,1.02), PEG+Simethicone without bisacodyl vs PEG (RR =1.00, 95% CI : 0.98,1.02) showed no difference on cecal intubation rate.There was aslo no significant difference on cecal intubation time.Abdominal bloating incidence was lower in PEG+Simethicone group than that in PEG group (RR=0.53, 95%CI : 0.31, 0.91, P=0.02). The meta-analysis result also showed a better acceptability in PEG+Simethicone group (RR=1.28, 95% CI : 1.01, 1.49, P=0.001). CONCLUSION: Adjunction of oral simethicone to polyethylene glycol as bowel preparation agent dose not improve cecal intubation rate on colonoscopy,but with better gastrointestinal tolerability and acceptability.


Assuntos
Catárticos/administração & dosagem , Colonoscopia/métodos , Polietilenoglicóis/administração & dosagem , Simeticone/administração & dosagem , Catárticos/efeitos adversos , Humanos , Intubação Intratraqueal , Polietilenoglicóis/efeitos adversos , Simeticone/efeitos adversos
16.
Dis Colon Rectum ; 62(12): 1518-1527, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31567921

RESUMO

BACKGROUND: Split-dose bowel preparation is recommended for morning colonoscopy, although a same-day dose regimen is an alternative for afternoon colonoscopy. Same-day preparation for morning colonoscopy has rarely been evaluated. OBJECTIVE: We compared the bowel cleansing efficacy, bowel movement kinetics, safety profile, and patient tolerability of split-dose and same-day preparation using 4-L polyethylene glycol. DESIGN: This was a prospective, randomized, assessor-blinded study. SETTINGS: This study was performed at a tertiary center in Korea. PATIENTS: Study subjects were randomly assigned to the same-day or split-dose groups. For the same-day dose group, 4 L of polyethylene glycol were ingested on the day of colonoscopy starting at 5:00 AM for morning colonoscopy or 7:00 AM for afternoon colonoscopy. In the split-dose group, 2 L of polyethylene glycol were ingested at 9:00 PM the day before colonoscopy, and the remaining 2 L from 7:00 AM for morning colonoscopy or from 10:00 AM for afternoon colonoscopy. Colonoscopy was performed from 10:00 AM. MAIN OUTCOME MEASURES: The efficacy of bowel cleansing was evaluated using the Boston bowel preparation scale. The participants completed questionnaires asking about adverse events, bowel movement kinetics, and tolerability of the preparation before colonoscopy. RESULTS: A total of 339 subjects were included (same-day dose = 172; split dose = 167). One subject in each group did not undergo colonoscopy. The rate of successful cleansing did not differ between the groups (same-day dose = 98.8% vs split dose = 98.2%; p = 0.681). There were no instances of hemodynamic instability or aspiration in either group. Tolerability, including overall satisfaction and willingness to reuse, were comparable between the groups. LIMITATIONS: This was a single-center study. CONCLUSIONS: The bowel cleansing efficacy, safety profile, and tolerability of same-day dosing with polyethylene glycol were comparable with those of split dose. Therefore, same-day dosing with 4 L of polyethylene glycol is a feasible bowel preparation method. See Video Abstract at http://links.lww.com/DCR/B44. COMPARACIÓN DE LA EFICACIA DE LA LIMPIEZA INTESTINAL, LA SEGURIDAD, LA CINÉTICA DEL MOVIMIENTO INTESTINAL Y LA TOLERABILIDAD DEL PACIENTE DE LA PREPARACIÓN INTESTINAL EN EL MISMO DÍA Y EN DOSIS DIVIDIDAS UTILIZANDO 4 L DE POLIETILENGLICOL: UN ESTUDIO PROSPECTIVO ALEATORIZADO: Se recomienda la preparación del intestino en dosis divididas para la colonoscopia de la mañana, aunque un régimen de una sola dosis el mismo día es una alternativa para la colonoscopia en la tarde. La preparación de una sola dosis el mismo día para la colonoscopia matutina rara vez se ha evaluado.Comparamos la eficacia de la limpieza intestinal, la cinética del movimiento intestinal, el perfil de seguridad y la tolerabilidad del paciente de la dosis dividida y la preparación el mismo día utilizando 4 L de polietilenglicol.Este fue un estudio prospectivo, aleatorizado, cegado por el evaluador.Este estudio se realizó en un centro terciario en Corea.Los sujetos del estudio fueron asignados aleatoriamente a el grupo de una dosis en el mismo día o al grupo de dosis dividida. Para el grupo de dosis del mismo día, se ingirieron 4 L de polietilenglicol el día de la colonoscopia a partir de las 5 a.m. para la colonoscopia de la mañana o las 7 a.m. para la colonoscopia de la tarde. En el grupo de dosis dividida, se ingirieron 2 L de polietilenglicol a las 9 p.m. el día anterior a la colonoscopia, y los otros 2 L restantes a partir de las 7 a.m. para la colonoscopia de la mañana o desde las 10 a.m. para la colonoscopia de la tarde. La colonoscopia se realizó a partir de las 10 a.m.La eficacia de la limpieza intestinal se evaluó mediante la escala de preparación intestinal de Boston. Los participantes completaron cuestionarios preguntando sobre los eventos adversos, la cinética del movimiento intestinal y la tolerabilidad de la preparación antes de la colonoscopia.Se incluyeron un total de 339 sujetos (dosis el mismo día, 172; dosis dividida, 167). Un sujeto en cada grupo no se sometió a colonoscopia. La tasa de limpieza exitosa no difirió entre los grupos (dosis el mismo día, 98.8% versus dosis dividida, 98.2%; p = 0.681). No hubo casos de inestabilidad hemodinámica o aspiración en ninguno de los grupos. La tolerabilidad, incluida la satisfacción general y la voluntad de reutilización, fueron comparables entre los grupos.Este fue un estudio de centro único.La eficacia de la limpieza intestinal, el perfil de seguridad y la tolerabilidad de la dosificación en el mismo día con polietilenglicol fueron comparables con los de la dosis dividida. Por lo tanto, la dosificación en el mismo día con 4 L de polietilenglicol es un método factible de preparación intestinal. Vea el video del resumen en http://links.lww.com/DCR/B44.


Assuntos
Catárticos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Idoso , Catárticos/efeitos adversos , Colonoscopia/estatística & dados numéricos , Defecação/efeitos dos fármacos , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Polietilenoglicóis/efeitos adversos , Estudos Prospectivos , Inquéritos e Questionários , Centros de Atenção Terciária , Resultado do Tratamento
17.
Am J Gastroenterol ; 114(10): 1671-1677, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31478919

RESUMO

OBJECTIVES: Patient navigation improves colorectal cancer screening among underserved populations, but limited resources preclude widespread adoption in minority-serving institutions. We evaluated whether a patient's self-selected social contact person can effectively facilitate outpatient screening colonoscopy. METHODS: From September 2014 to March 2017 in an urban tertiary center, 399 black participants scheduled for outpatient screening colonoscopy self-selected a social contact person to be a facilitator and provided the person's phone number. Of these, 201 participants (50.4%) were randomly assigned to the intervention arm for their social contact persons to be engaged by phone. The study was explained to the social contact person with details about colonoscopy screening and bowel preparation process. The social contacts were asked to assist the participants, provide support, and encourage compliance with the procedures. The social contact person was not contacted in the usual care arm, n = 198 (49.6%). We evaluated attendance to the scheduled outpatient colonoscopy and adequacy of bowel preparation. Analysis was performed by intention to treat. RESULTS: The social contact person was reached and agreed to be involved for 130 of the 201 participants (64.7%). No differences were found in the proportion of participants who underwent screening colonoscopy (77.3% vs 77.2%; relative risk = 1.01; 95% confidence interval: 0.91-1.12), but there was a modest increase in the proportion with adequate bowel preparation with social contact involvement (89.1% vs 80.9%; relative risk = 1.10; 95% confidence interval: 1.00-1.21). DISCUSSION: Engaging a patient's social network to serve in the role of a patient navigator did not improve compliance to outpatient screening colonoscopy but modestly improved the adequacy of bowel preparation.


Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Rede Social , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Catárticos/administração & dosagem , Detecção Precoce de Câncer/psicologia , Feminino , Humanos , Masculino , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Cooperação do Paciente/psicologia , Navegação de Pacientes/métodos , Polietilenoglicóis/administração & dosagem
18.
Khirurgiia (Mosk) ; (8. Vyp. 2): 60-64, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31502595

RESUMO

Mechanical bowel preparation used to be a standard procedure for a long time. Nowadays routine use of MBP seems to be debatable thus alternative approaches, e.g. avoiding any bowel preparation completely or using of MBP with oral antibiotics are considered. Data on performing different kinds of bowel preparation is reviewed in this article.


Assuntos
Antibacterianos/administração & dosagem , Catárticos/administração & dosagem , Colectomia , Cuidados Pré-Operatórios/métodos , Protectomia , Administração Oral , Procedimentos Cirúrgicos Eletivos , Humanos
19.
Int J Colorectal Dis ; 34(11): 1857-1863, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31520200

RESUMO

BACKGROUND: Colon capsule endoscopy (CCE) is a reliable method to detect colonic polyps in the well-prepared colon. As CCE evaluation can be time consuming, a new software algorithm might aid in reducing evaluation time. OBJECTIVES: The aim of the study was to evaluate whether it is feasible to reliably detect colon polyps in CCE videos with a new software algorithm the "collage mode" (Rapid 8 Software, Covidien/Medtronic®). METHODS: Twenty-nine CCE videos were randomly presented to three experienced and to three inexperienced investigators. Videos were evaluated by applying the collage mode. Investigation time was documented and the results (≥one polyp vs. no polyp) were compared with the findings of two highly experienced central readers who read the CCE videos in the standard mode beforehand. RESULTS: It took a median time of 9.8, 3.5, and 7.5 vs. 4.3, 4.6 and 12.5 min for experienced vs. inexperienced investigators to review the CCE videos. For detecting ≥one polyp vs. no polyp, sensitivity of 93.3%, 73.3%, and 93.3% was observed for the experienced and sensitivity of 46.7%, 33.3%, and 93.3% for the inexperienced CCE readers. CONCLUSION: Collage mode might allow for a quick review of CCE videos with a high polyp detection rate for experienced CCE readers. Future prospective studies should include CCE collage mode for rapid polyp detection to further prove the feasibility of practical colon polyp detection by CCE and possibly support the role of CCE as a screening tool in CRC prevention.


Assuntos
Algoritmos , Endoscopia por Cápsula , Colo/diagnóstico por imagem , Colo/patologia , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico , Software , Catárticos , Humanos , Fatores de Tempo , Gravação em Vídeo
20.
World J Gastroenterol ; 25(34): 5017-5025, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31558854

RESUMO

Anastomotic leak (AL) constitutes a significant issue in colorectal surgery, and its incidence has remained stable over the last years. The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned. The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration, such as the intravenous route or enema. In parallel, preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens, as identified by the microbiome analysis. AL can be further reduced by fluorescence angiography, which leads to significant intraoperative changes in surgical strategies. Implementation of fluorescence angiography should be encouraged. Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications.


Assuntos
Fístula Anastomótica/prevenção & controle , Colo/cirurgia , Cuidados Pré-Operatórios/métodos , Reto/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Antibacterianos/administração & dosagem , Catárticos/administração & dosagem , Colo/diagnóstico por imagem , Colo/microbiologia , Enema , Angiofluoresceinografia , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Incidência , Cuidados Pré-Operatórios/efeitos adversos , Reto/diagnóstico por imagem , Reto/microbiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento
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