Primary study on clinical applications of second generation colon capsule endoscopy / 中华消化杂志

Objective@#To explore the clinical applications of second generation colon capsule endoscopy (CCE-2).@*Methods@#From July 2017 to December 2018, at the First Affiliated Hospital, College of Medicine, Zhejiang University, 40 outpatients and hospitalized patients who underwent CCE-2 examination were enrolled. The examination results were analyzed by an expert gastroenterologist with rich experience in small intestinal and colon capsule endoscopy. The stomach, small bowel and colon transit time, the score of colon cleansing quality, the completion rate of colon capsule examination, lesion detection and adverse effects were observed. Chi-square test and Student′t test were used for statistical analysis.@*Results@#The whole gastrointestinal tract examination was completed during the capsule running time in 65.0% (26/40) of the patients. The average stomach transit time was (0.92±0.74) h, the small bowel transit time was (3.93±1.51) h and the colon transit time was (4.89±0.61) h. The capsule running time of patients who completed the whole gastrointestinal tract examination was shorter than that of patients who did not complete the whole gastrointestinal tract examination ((9.44 ± 3.53) h vs. (15.47±2.09) h), and the difference was statistically significant (t=6.79, P<0.01). The qualified rate of colon preparation was 67.5% (27/40). There were no statistically significant differences in colon transit time or capsule excretion time between patients with qualified colon preparation and poor colon preparation ((4.43±3.33) h vs. (5.96 ± 2.44) h; and (9.06 ± 3.91) h vs. (10.29±2.47) h; t=1.17 and 0.81, both P>0.05). A total of 33 (82.5%) patients had gastrointestinal lesions detected by colon capsule, including three cases of esophageal lesions (inflammation and mass), 21 cases of gastric lesions (chronic gastritis, mucosal protrusion, polyp and ulcer), nine cases of small bowel lesions (polyp, ulcer and vascular malformation) and 19 cases of colonic lesions (diverticulum, polyp, rectitis, mucosal erosion, ulcer and vascular malformation, internal hemorrhoids). Among them, there were 11 patients with two or more lesions. No adverse events occurred during the examination and all the capsules were excreted within 48 hours.@*Conclusion@#CCE-2 with high safety and good tolerance can be used for whole gastrointestinal tract examination.

Utilidad de la preparación mecánica anterógrada en cirugía colorrectal electiva: resultados de una serie prospectiva y aleatoria / Usefulness of anterograde mechanical colon cleansing in colorectal surgery

Background: Anterograde mechanical colon cleansing is routinely done before colorectal surgery. However there is no firm evidence about its usefulness. Aim: To assess the usefulness of anterograde mechanical colon cleansing in colon surgery. Patients and Methods: Participants requiring elective colorectal surgery were randomized to receive anterograde mechanical bowel cleansing with two doses of oral sodium phosphate (Oral fleet) or a liquid diet 24 hours prior to surgery, after signing an informed consent. Both groups received antimicrobial prophylaxis. Problems associated with bowel cleansing, subjective assessment of bowel preparation by the surgeon and postoperative complications were recorded. Results: One hundred twenty two participants were studied (73 females). Fifty three percent of patients had concomitant diseases such as hypertension and diabetes mellitus. Sixty patients were subjected to anterograde bowel cleansing and 62 were ascribed to the liquid diet group. Surgeons evaluated colon cleansing as good in 49 and 37 patients with and without anterograde mechanical cleansing, respectively and as regular in 8 and 23 patients, respectively (X2 = 9.1 p = 0.01). Tolerance to cleansing was evaluated as good, fair and poor by 50, 30 and 20 percent of patients, respectively. One patient had a bowel obstruction associated with the use of sodium phosphate. Postoperative complications occurred in 14 and 23 patients subjected or not to cleansing, respectively (p = 0.06). Septic complications occurred in 11 and 3 cases with and without colon cleansing, respectively (p < 0.01). Conclusions: Anterograde mechanical colon cleansing was associated with a higher incidence of septic complications in this series of patients.

Introducción: El uso de la preparación mecánica anterógrada (PMA) es una práctica rutinaria en cirugía colorrectal pero con escasas bases en la evidencia científica. Objetivo: Determinar la utilidad de la PMA en una serie prospectiva y aleatoria de cirugía colorrectal electiva. Resultados: La serie corresponde a 122 pacientes, 60 de los cuales recibe PMA. Los datos epidemiológicos muestran que los grupos son comparables. En esta serie se encuentra un riesgo de morbilidad global aumentado al doble en los pacientes que reciben PMA, así como un riesgo de infección superficial del sitio quirúrgico seis veces mayor. No se encuentran diferencias en las infecciones profundas, dehiscencia de anastomosis ni en las reintervenciones. Las complicaciones asociadas a la PMA se presentaron sólo en un caso, 10 que no alcanza significación estadística. Conclusiones: De acuerdo a nuestros resultados, no se justifica la utilización rutinaria de PMA.

A Prospective Randomized Trial Comparing Divided Dose of Polyethylene Glycol Solution with Stimulant Laxative Plus Low Dose Polyethylene Glycol Solution for Colon Cleansing / 대한소화기내시경학회지

BACKGROUND/AIMS: This study compared the efficacy and patient's tolerance between those given a divided dose of a polyethylene glycol solution (PEG) and those given a stimulant laxative plus a reduced dose of PEG. METHODS: 190 consecutive patients for colon cleasing were randomized into 3 groups. In group A, 2 L of PEG was administered on the evening prior to the colonoscopy followed by 2 L of the same solution on the morning of colonoscopy. In group B, 2 L of PEG was administered in the morning only. In group C, 2 bisacodyl tablets (10 mg) were administered on the evening prior to colonoscopy and 2 L of PEG was administered in the morning. The patients completed a questionnaire to assess their tolerance to the bowel preparation before the colonoscopy. The endoscopists scored the adequacy of the bowel preparation using the Ottawa scale along with their satisfaction with the quality of the procedure. RESULTS: While 4 patients (6.7%) could not completely take the recommended dose in group A, all patients in groups B and C could take the recommended dose (p=0.012). The patients in Group B had a better tolerance and fewer side effects than those in Group A (p=0.01). A higher adequacy of bowel preparation was observed in group A than in group B (p=0.000) and there appeared to be a higher adequacy of bowel preparation in Group C than in Group B (p=0.06). CONCLUSIONS: The 2 L PEG solution only does not appear to be as effective as a bowel cleansing agent for colonoscopy compared with the divided 4 L PEG solution. No statistical difference in the side effects and efficacy was observed between the divided 4 L PEG solution and the combination of bisacodyl 10 mg with 2 L of a PEG solution.

Comparison of 4 L of PEG Versus Combination of 2 L of PEG and 45 mL of Sodium Phosphate for Colonoscopy Colon Cleansing: A Prospective Randomized Trial / 대한소화기내시경학회지

BACKGROUND/AIMS: Polyethyleneglycol (PEG) is safe but its large volume and bad taste reduces patients' compliance. Sodium phosphate (NaP) is a hyperosmotic agent and its small volume can increase patients' compliance but electrolyte imbalance is a problem. Therefore, we conducted a study to determine whether patients' compliance can be enhanced and electrolyte imbalance reduced by combining these two agents. METHODS: Forty-one admitted patients receiving colonoscopy at Korea University Hospital from June 28, 2004 to August 14, 2004 were randomly divided into two groups for colon cleansing with either PEG 4 L (n=21) or PEG 2 L plus NaP 45 mL (n=20). Patients were assessed for patient tolerance, quality of preparation, and changes of biochemical parameters. RESULTS: Overall discomfort was statistically lower in the combination group, PEG 2 L plus NaP 45 mL (p=0.035). Although patients in the combination group reported less fullness (p=0.076) and nausea (p=0.087), the findings were not statistically significant. The quality of the preparation was comparable between the two groups (p=0.872). The phosphorus level in the combination group showed a statistically significant increase (0.58+/-0.46) after colon cleansing (p=0.020) but was not clinically significant. CONCLUSIONS: The combination of NaP 45 mL and PEG 2 L showed less overall discomfort with comparable quality of preparation and without serious electrolyte abnormality compared to 4 L of PEG. Therefore, the combination of NaP 45 mL and PEG 2 L could be used as an alternative colonoscopic colon cleansing agent when patients have trouble taking 4 L of PEG alone.

Effectiveness of Walking-exercise on Bowel Preparation for Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: This prospective study was conducted to assess the effect of walking-exercise on the bowel cleansing before colonoscopy and to define subgroup of patients to whom walking-exercise was beneficial. METHODS: Before taking 2.5 L of polyethylene glycol, 393 out-patients were randomized into two groups (G1; walking-exercise, G2; non-exercise) and the amount of walking-exercise was estimated by the step counter. A single colonoscopist performed the procedure with a single-blinded manner and estimated the bowel cleansing. RESULTS: A total of 366 patients were included by per protocol analysis. The number of step count was significantly different between two groups (p<0.000). However, the groups were similar in other data collected. The degree of bowel cleansing between two groups was significantly different (p<0.01). Age, history of abdominal surgery, constipation, obesity and walking- exercise were related to the degree of bowel cleansing. Interestingly, walking-exercise was especially beneficial to patients with age less than 65 years, without history of abdominal surgery, and non-obesity. Multivariate analysis demonstrated that absence of constipation (OR=4.74), walking- exercise (OR=2.04), and younger age (OR=1.97) were independent factors associated with better bowel cleansing. Most of walking patients (97.4%) answered that walking-exercise is more comfortable than taking the solution. CONCLUSIONS: The walking-exercise was of an additional benefit to improve colonoscopic bowel cleansing without significant patients discomfort.

Comparing Bowel Cleansing Methods

BACKGROUND: Over the past several years, orthograde, peroral, and polyethylene glycol-electrolyte lavage (PEG-EL) has become the popular bowel cleansing agent before colonoscopic and surgical procedures on the colon and the rectum. Despite its proven efficacy, PEG-EL is difficult for some patients to tolerate. This has led to trials of a smaller-volume preparation (90 ml) using a sodium-phosphatebased laxative (NaP). There are reports of significant hyperphosphatemia following oral NaP and case reports of hypocalcemic tetany after NaP enemas. The purpose of this investigation was to assess 1) the changes in biochemical parameters and body weight, 2) the amount of residual stool, and 3) the side effects and patients satisfaction. METHODS: Sixty consecutive outpatients were prospectively randomized to undergo colonic cleansing with conventional PEG-LE or NaP. We analyzed the serum levels of sodium, potassium, magnesium, calcium, phosphate, BUN, albumin, and hematocrit at pre- and post-preparation. RESULTS: Serum sodium and phosphate levels increased significantly after NaP preparation. The changes of other elements were similar in both groups. The overall quality of colon cleansing and the frequency of satisfactory preparation were high in patients administered NaP. CONCLUSIONS: Preparation with NaP is a well-tolerated, efficacious alternative to conventional PEG-EL.