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
Postoperative complications of colorectal surgery are one of the most important reasons affecting patients' postoperative health and also an important factor increasing the burden of medical care. It can give policymakers a basis to the optimization of medical resources by clarifying the health economic burden of different postoperative complications through health economic evalua-tion. Through a detailed search of domestic and foreign literatures, the authors summarize and analyze the increased medical costs and prolonged hospital stays associated with postoperative anastomotic leak, surgical site infection, and postoperative ileus. Furthermore, the authors identify shortcomings in existing clinical studies of different mediacal centers for colorectal postoperative complications, in order to better guide future clinical researches related to colorectal postoperative complications.
ABSTRACT
Objective To analyze the causes of delayed hemorrhage after colonoscopic treatment in colorectal diseases and the value of second colonoscopic treatment.Methods A retrospective study was conducted on 45 patients with colorectal protrusion lesions (polyps,adenoma,early carcinoma and lipoma) in the Daping hospital of the Third Military medical University from January 2010 to December 2016.The patients suffered from delayed hemorrhage after argon knife coagulation,submucosal resection,submucosal dissection or nylon snares colonoscopic treatment.The mode and clinical outcome of second colonoscopic treatment were summarized by aiming at the reasonsof delayed hemorrhage.Results The predilection sites of delayed hemorrhage were in turn rectum (28.89 ％),sigmoid colon (24.44 ％) and ascending colon (22.22 ％).Adenoma and intraepithelial neoplasia lesions were easier to occurr (88.89 ％).The types of delayed hemorrhage were mainly blood oozing at the lesion resection wound surface as well as blood gushing or ejection.The second colonoscopic treatment modes in these cases were mainly titanium clipping and ring clipping and suturing.Five cases were treated by submucosal injection of adrenaline (1 ∶ 10 000) combined with argon knife coagulation.Thirtyfive cases conducted argon knife coagulationcombined with titanium clipping,3 cases conducted titanium clipping and 2 cases adopted ring clipping hemostasis.Forty-two cases stopped bleeding by once colonoscopic treatment,while 3 cases suffered from re-bleeding,the colonoscopic treatment was performed again,1 case stopped bleeding after using titanium clipping and ring clipping hemostasis again,while other 2 cases were transfered to the surgery department for conducting colectomy.All 43 cases of delayed hemorrhage in this group were cured and discharged after successful hemostasis by colonoscopy.The firm wound treatment after colonoscopic treatment was very important for preventing delayed hemorrhage,and the underlying diseases and postoperative diet management were also the important factors of delayed hemorrhage.Conclusion Timely second colonoscopic examination and treatment can obtain satisfactory clinical effects in the patients sufferring from delayed hemorrhage after colonoscopic treatment.
ABSTRACT
PURPOSE: Laparoscopic colorectal procedures are widely used for benign disease but controversial for malignant disease. In early colorectal cancer, laparoscopic colectomy can be performed safely on the basis of oncologic principles. The purpose of this study is to evaluate the safety and effectiveness of laparoscopic-assisted colorectal resection for malignant polyps and benign disease. METHODS: Twenty five patients submitted to surgical treatment between Oct. 1996 to June 2000 were reviewed retrospectively. RESULTS: Malignant polyps comprized 7 cases whose resection margins were all positive for cancer cells after endoscopic polypectomy and benign diseases in 18 cases (benign polyp: 7, diverticular disease: 4, submucosal tumor: 4 etc.). The common sugical procedures were anterior or low anterior resection (7 cases) and segmental resection (6 cases). There was no conversion to an open surgery. In malignant polyps, pathologic results revealed early cancer with no lymph node metastasis. There was no operative mortality. Postoperative recovery was uneventful except 2 cases (9.0%) of complications, which were, prolonged ileus in one patient and subcutaneous emphysema in another patient. CONCLUSIONS: Laparoscopic-assisted resection can be recommended as a safe and effective procedure for treatment of colonic malignant polyps and benign disease.