Lactulose vs Polyethylene Glycol for Bowel Preparation: A Single-Center, Prospective, Randomized Controlled Study Based on BMI.

INTRODUCTION: Colonoscopy is currently considered as one of the principal techniques to diagnose the colorectal diseases. Admittedly, qualified bowel preparation before colonoscopy is a premise for high-quality examination. Lower quality bowel preparation might seriously impede visualization of the intestinal mucosa, resulting in missed and misdiagnosed intestinal lesions. Therefore, it is necessary to choose the appropriate oral laxative based on the guarantee of safety and efficacy. METHODS: This prospective randomized controlled study was conducted to compare lactulose oral solution and polyethylene glycol (PEG) electrolyte powder for bowel preparation using the following indicators: Boston Bowel Preparation Scale, Bowel Bubble Score, detection rate of adenoma and lesion, patients' satisfaction, and adverse effects. Our study investigated the suitability of 2 bowel preparation reagents for patients with different body mass indices mainly based on body mass index (BMI). RESULTS: In the lactulose group, there was a significant improvement in the quality of bowel preparation compared with those in the PEG group ( P < 0.05), especially in people with normal BMI and higher BMI. Compared with the PEG group, individuals in the lactulose group had a significantly higher adenoma detection rate (50% vs 33.5%, P < 0.05) and taste scores (8.82 vs 6.69, P < 0.05), as well as significantly fewer adverse reactions (6.5% vs 32.5%, P < 0.05). DISCUSSION: Lactulose oral solution is superior to PEG in bowel preparation quality and taste, especially in normal BMI and higher BMI groups. It can be used clinically as a potential and promising bowel preparation agent in the future. Clinical Trial registration number: ChiCTR2100054318.

Influence on the results and safety of double-balloon enteroscopy at different combination time / 中华消化内镜杂志

Objective:To evaluate the influence on the results and safety of double-balloon enteroscopy (DBE) at different combination time.Methods:Patients who received combined DBE procedures in Nanjing Drum Tower Hospital from April 2019 to August 2020 were divided into the one-day combination group and the non-one-day combination group. The complete enteroscopy rate, time of anterograde approach, time of retrograde approach, total time of combined approach, adverse events, hospital stay and cost were compared.Results:Among 119 patients who received DBE, 23 patients were excluded due to small intestinal stenosis. The complete enteroscopy rate was 92.9% (39/42) in the one-day group and 74.1% (40/54) in the non-one-day group, showing significant difference ( χ2=4.390, P=0.036). There were significant differences in the time of retrograde approach (35.59±23.29 min VS 55.10±19.04 min, t=-4.080, P<0.001), total time of combined approach (89.10±27.82 min VS 114.20±24.55 min, t=-4.254, P<0.001), hospital stay (9.24±3.76 d VS 11.76±4.41 d, t=-2.599, P=0.011) between the two groups. There were no significant differences in the time of anterograde approach, hospital cost or adverse events between the two groups. Conclusion:Combined DBE on one day yields a higher complete enteroscopy rate, less examination time and less hospital stay, which is worth of clinical application.

Effects of balloon-assisted enteroscopy for benign stenosis in deep small intestine (with video) / 中华消化内镜杂志

To review the clinical data of 13 patients with benign stenosis in deep small intestine treated by balloon-assisted enteroscopy from September 2017 to December 2019, and to evaluate the stenosis characteristics, endoscopic treatment effects and its safety in different lesions. The results showed that there were 6 cases of Crohn disease (CD), 4 cases of cryptogenic multifocal ulcerative stenosing enteritis (CMUSE) and 3 cases of small bowel stenosis with unknown etiology. A total of 38 stenoses were found after 17 enteroscopic treatments, including 35 web-like stenoses and 3 columnar stenoses. Thirteen stenoses were found in 6 patients with CD, including 4 single stenosis, 1 case of 3 stenoses and 1 case of 6 stenoses. Twenty-one stenoses were found in 4 patients with CMUSE and they were all web-like stenosis. A total of 18 times of balloon dilatation and 10 times of IT knife incision were performed. The technical success rate was 88.2% (15/17), and the clinical effective rate was 76.9% (10/13). The follow-up time was 3-28 months, and one patient underwent surgical treatment. There was 1 case of delayed hemorrhage and 3 cases of delayed perforation after operation. They were all improved by medical treatment. These results indicated that treatment of benign stenosis in deep small intestine by enteroscopy is technically feasible and can improve the symptoms of patients in a short time.

Preliminary study on 5-aminosalicylic acid in a mouse model of colitis-associated carcinoma / 中华消化杂志

Objective To investigate the expressions of peroxisome proliferator activated receptor-γ (PPAR-γ) and β-catenin in 5-aminosalicylic acid （ASA) intervened colitis carcinogenesis mouse model induced by azoxymethane (AOM) and dextran sulfate sodium (DSS).Methods Thirtysix BALB/c mice were evenly divided into control group,model group,and intervention group.For model group and intervention group,mice were intraperitoneally injected with AOM (10 mg/kg) one day before experiment,then drank 4％ DSS solution freely for one week and followed with common drinking water for another two weeks.Taking 4％ DSS solution and common drinking water repeated for three cycles.For intervention group,5-ASA (150 mg/kg) was given from three days before experiment to the end of research.For control group,mice were intraperitoneally injected with 0.9％NaCl solation and then given common drinking water for nine weeks.The symptoms of the disease were monitored in mice and pathological changes of tissues were evaluated at the end of first week and ninth week.At the end of the ninth week,the expressions of PPAR-γ,β-catenin protein and PPAR-γat mRNA level in colon tissue were detected.The data were analyzed by t test.Results The colitis disease activity index (DAI) index of intervention group was 1.81 ±0.59 after drinking DSS solution for one week and the number of tumor was 4.11 ± 1.05 at the end of the ninth week,both were significantly lower than those of model group (2.47 ± 0.53 and 9.71±2.29 respectively,t=2.88 and 6.55; both P＜0.01).The expression of PPAR-γ at protein level (2.11±1.36) and mRNA level (1.45±0.10) in colon tissue of intervention group significantly increased compared with those of model group (0.43±0.53 and 0.57±0.08 respectively,t=3.07 and 18.99,both P＜0.01).There was no significant difference of β-catenin expression among groups (P＞0.05).Conclusions 5-ASA can efficiently improve the inflammatory reaction and tumor load in AOM and DSS induced colitis carcinogenesis mouse model,and at the same time can promote the expression of PPAR-γ in colon.However,there was no significant influence on the expression of β-catenin.