The effects of cisapride on the quality and tolerance of colonic lavage: a double-blind randomized study.

Colonic lavage is a preferred preparation for colonoscopy although this type of preparation does not always result in optimal cleansing. We postulated that cisapride, a new prokinetic agent, might improve the cleansing of the colon and ameliorate patient discomfort. Of 84 patients undergoing colonoscopy, 41 were randomized (double-blind) to Golytely plus cisapride (10 mg per OS three times during the day before the procedure and one 10-mg dose on the morning of the procedure) and 43 to Golytely plus a placebo of identical appearance. The adequacy of the preparation was scored on a five-point grading scale for each anatomic segment and for the overall impression. A questionnaire was also used to assess each patient's symptoms during lavage. The mean overall preparation score in the cisapride group was 4.0, compared with 3.7 for the placebo group (p = .54). In the transverse colon, the mean preparation score was higher for the cisapride group (4.3 versus 3.8, p = .02). Differences in symptom scores between the two groups were not significant. In conclusion, the use of cisapride may improve visualization of the transverse colon, but it did not result in significant improvement in the overall preparation score. Changes in the dosage of cisapride should be further evaluated.

Push and sonde enteroscopy for the diagnosis of obscure gastrointestinal bleeding.

OBJECTIVE: The combination of push and sonde enteroscopy permits endoscopic evaluation to extend the distal small bowel. Our objective was to determine the yields of both push and sonde enteroscopy in patients with obscure GI bleeding. METHODS: We retrospectively reviewed 553 small bowel examinations performed with an orally passed 135-cm pediatric colonoscope in combination with a 2750-cm per nasal sonde enteroscope to investigate the small bowel for sources of gastrointestinal bleeding of obscure origin. RESULTS: The examination reached the distal jejunum or beyond in over 90% of patients undergoing both push and sonde enteroscopy. The yield of these combined studies was 58% for identifying a possible source of gastrointestinal blood loss. In 40% of the examinations, the abnormality was found distal to the limits of routine upper gastrointestinal endoscopy. In 26% of all examinations, the lesion was detectable only by sonde enteroscopy. The most common small bowel findings were mucosal vascular lesions (31% of all exams) and tumors (6%). No major endoscopic complications occurred, and patients tolerated the procedures well. CONCLUSIONS: The combination of push and sonde enteroscopy is a valuable tool in the evaluation of obscure gastrointestinal bleeding and may provide useful information necessary to formulate treatment plans aimed at cessation of bleeding.

Sequelae after esophageal variceal ligation and sclerotherapy: a prospective randomized study.

OBJECTIVES: Esophageal variceal ligation is a new approach to the treatment of esophageal varices that does not result in transmural tissue injury and inflammation, and therefore might produce fewer sequelae and symptoms than sclerotherapy. We conducted a prospective, randomized comparison of sclerotherapy with ligation to study the relative short-term risks of these two procedures with respect to bacteremia, pulmonary and coagulation function, esophageal motility, and gastroesophageal reflux. METHODS: Patients with previously documented high grade esophageal varices were randomized to receive sclerotherapy or ligation. Blood was drawn for culture and coagulation profiles, and patients underwent pulmonary function tests, esophageal manometry, and intraesophageal pH monitoring before and after treatment. RESULTS: Six patients with Childs class B cirrhosis and one patient with pre-sinusoidal portal hypertension underwent 20 courses of therapy. Neither sclerotherapy nor ligation produced significant clinical changes in pulmonary or coagulation parameters, or bacteremia requiring treatment. The majority of ligation treatments were without worsening of motility or reflux scores, and none were associated with symptoms. Sclerotherapy was followed by significantly greater esophageal dysmotility and worsening reflux patterns. CONCLUSIONS: Patient acceptance of ligation was much greater than that for sclerotherapy. Our data define the advantages of ligation over sclerotherapy.

Ten years of screening for cancer in a family practice.

The Cohocton office of Tri-County Family Medicine has maintained an active screening program for breast cancer, colorectal cancer, and cervical cancer since 1974. This article reports a retrospective study of all patients with a diagnosis of cancer during the ten-year period from July 1974 to June 1984. Particular attention was paid to the relationship of screening to the diagnosis of these cancers. Sixty-nine cancers were diagnosed during the study period. Screening detected 7 of 11 breast cancers, 2 of 11 colorectal cancers, and 2 of 3 cervical cancers. In addition, all cases of respiratory cancer occurred in cigarette smokers and were therefore theoretically preventable. The data suggest that a large population of inactive, unscreened patients is a major obstacle to cancer prevention.