Colonoscopia com infusão de água: revisão sistemática / Water infusion colonoscopy: a systematic review

Objetivo: verificar os benefícios do método de colonoscopia com água versus ar, e esclarecer as limitações dos estudos e revisões sistemáticas preexistentes em relação à taxa e tempo de intubação cecal, taxa de detecção de adenomas, duração da colonoscopia, e incidência de dor. Método: revisão sistemática da literatura sem metanálise. Resultados: em relação à taxa de intubação cecal, não houve aumento significante com o método de água; o tempo de intubação cecal foi significantemente mais longo com o método de água em dois estudos; a taxa de detecção de adenomas apresentou-se numericamente maior, sem apresentar diferença significante; a duração total do exame foi significantemente maior no método de água em apenas um estudo; em relação à dor, houve redução significativa da dor no método com água em relação ao método com insuflação de ar. Conclusão: o principal benefício do método de colonoscopia com infusão de água é a redução significativa da dor durante o procedimento, entretanto, foram encontrados diversos problemas em relação aos dez estudos avaliados e às revisões sistemáticas preexistentes. Concluiu-se pela necessidade de maiores pesquisas para confirmação dos dados.

Objective: to check the benefits of water colonoscopy method versus air insuflation colonoscopy method, and clarify the limitations of the pre-existing studies and systematic reviews in relation to the cecal intubation rate and time, adenoma detection rate, procedural time, and pain incidence. Method: systematic literature review without meta-analysis. Results: regarding the cecal intubation rate, the water method does not show significant increase; cecal intubation time was significantly longer with the water method, in two studies; the adenomas detection rate had presented numerically greater, although there was no significant difference; total colonoscopy procedural time was significantly greater in water method, only in one study; in relation to pain, there was a statistically significant reduction in pain with water method, compared to the air insufflation method. Conclusion: the main benefit of the water colonoscopy method is significant reduction in pain during the procedure. However, several problems were found in the ten assessed studies and in pre-existing systematic reviews. We concluded by the need for further research to confirm the data.

Lower cardiac vagal tone in non-obese healthy men with unfavorable anthropometric characteristics

Objectives: to determine if there are differences in cardiac vagal tone values in non-obese healthy, adult men with and without unfavorable anthropometric characteristics. Introduction: It is well established that obesity reduces cardiac vagal tone. However, it remains unknown if decreases in cardiac vagal tone can be observed early in non-obese healthy, adult men presenting unfavorable anthropometric characteristics. Methods: Among 1688 individuals assessed between 2004 and 2008, we selected 118 non-obese (BMI <30 kg/m²), healthy men (no known disease conditions or regular use of relevant medications), aged between 20 and 77 years old (42 ± 12-years-old). Their evaluation included clinical examination, anthropometric assessment (body height and weight, sum of six skinfolds, waist circumference and somatotype), a 4-second exercise test to estimate cardiac vagal tone and a maximal cardiopulmonary exercise test to exclude individuals with myocardial ischemia. The same physician performed all procedures. Results: A lower cardiac vagal tone was found for the individuals in the higher quintiles - unfavorable anthropometric characteristics - of BMI (p=0.005), sum of six skinfolds (p=0.037) and waist circumference (p<0.001). In addition, the more endomorphic individuals also presented a lower cardiac vagal tone (p=0.023), while an ectomorphic build was related to higher cardiac vagal tone values as estimated by the 4-second exercise test (r=0.23; p=0.017). Conclusions: Non-obese and healthy adult men with unfavorable anthropometric characteristics tend to present lower cardiac vagal tone levels. Early identification of this trend by simple protocols that are non-invasive and risk-free, using select anthropometric characteristics, may be clinically useful in a global strategy to prevent cardiovascular disease.