1-L polyethylene glycol + ascorbic acid versus sodium picosulfate + magnesium citrate bowel preparations for colonoscopy: effectiveness and safety.

BACKGROUND: adequate bowel preparation is crucial for the protective effect of colonoscopy. Commonly used preparation regimens like polyethylene glycol (PEG) or sodium picosulfate with magnesium citrate (SPMC) have shown similar results in clinical trials, but low-volume PEG + ascorbic acid (1-L PEG + ASC) versus SPMC have never been compared in a real-life setting. AIM: to evaluate the effectiveness and safety of 1-L PEG + ASC versus SPMC in a real-life setting for the overall population, for patients aged ≥ 65 years, and males versus females. METHODS: out-patients aged ≥ 18 years who underwent colonoscopy for any indication were randomly assigned to the 1-L PEG + ASC or SPMC group. Using the Boston Bowel Preparation Scale (BBPS), the primary endpoints were the bowel cleansing success of the overall colon and right colon, as well as high-quality (HQ) cleansing. Furthermore, the effectiveness and safety outcomes for age groups and males versus females were compared. RESULTS: 1-L PEG + ASC showed significantly better bowel cleansing success than SPMC. Particularly remarkable is the HQ cleansing reached with 1-L PEG + ASC compared with SPMC (55.5 % versus 25.4 % in the overall colon, and 58.7 % versus 27.2 % in the right colon). 1-L PEG + ASC was equally effective for men and women while SPMC showed significant differences between genders (men had worse bowel cleansing). Age did not affect the cleansing effectiveness. 1-L PEG + ASC versus SPMC showed significant differences in tolerance and safety; women also had significantly worse tolerance than men for both solutions, but these did not affect the quality of bowel cleansing. CONCLUSIONS: in our real-life setting, 1-L PEG + ASC offered better adequate and HQ bowel cleansing than SPMC, achieving excellent cleansing quality, regardless of gender or tolerance.

1-L polyethylene glycol + ascorbic acid versus sodium picosulfate + magnesium citrate bowel preparations for colonoscopy: effectiveness and safety

Background: adequate bowel preparation is crucial for the protective effect of colonoscopy. Commonly used preparation regimens like polyethylene glycol (PEG) or sodium picosulfate with magnesium citrate (SPMC) have shown similar results in clinical trials, but low-volume PEG + ascorbic acid (1-L PEG + ASC) versus SPMC have never been compared in a real-life setting. Aim: to evaluate the effectiveness and safety of 1-L PEG + ASC versus SPMC in a real-life setting for the overall population, for patients aged ≥ 65 years, and males versus females. Methods: out-patients aged ≥ 18 years who underwent colonoscopy for any indication were randomly assigned to the 1-L PEG + ASC or SPMC group. Using the Boston Bowel Preparation Scale (BBPS), the primary endpoints were the bowel cleansing success of the overall colon and right colon, as well as high-quality (HQ) cleansing. Furthermore, the effectiveness and safety outcomes for age groups and males versus females were compared. Results: 1-L PEG + ASC showed significantly better bowel cleansing success than SPMC. Particularly remarkable is the HQ cleansing reached with 1-L PEG + ASC compared with SPMC (55.5 % versus 25.4 % in the overall colon, and 58.7 % versus 27.2 % in the right colon). 1-L PEG + ASC was equally effective for men and women while SPMC showed significant differences between genders (men had worse bowel cleansing). Age did not affect the cleansing effectiveness. 1-L PEG + ASC versus SPMC showed significant differences in tolerance and safety; women also had significantly worse tolerance than men for both solutions, but these did not affect the quality of bowel cleansing. Conclusions: in our real-life setting, 1-L PEG + ASC offered better adequate and HQ bowel cleansing than SPMC, achieving excellent cleansing quality, regardless of gender or tolerance. (AU)

Initial experience with a homemade "hybrid-tome" for needle-knife precut in patients with difficult biliary cannulation.

Background and study aims Current clinical guidelines recommend needle-knife precut (NKP) as the primary and best method for performing a biliary cannulation (BC) when simple techniques fail and the criteria are met for difficult BC (DBC). However, many endoscopists avoid or defer early NKP in favor of alternative, simpler techniques that have not been shown to be either safer or more effective. Our goal is to test a device that provides the needle-knife papillotome (NKPT) with traction capability and which can facilitate the learning and execution of NKP. Patients and methods This was a descriptive bicentric observational study of a personal cohort of patients undergoing early NKP to analyse the efficacy and safety of the technique with a "hybrid-tome" (HT) built using the isolated core of a NKPT and a conventional canulotome. Results Over a 4-year period, we performed 43 NKPs with the HT, achieving BC in one or two steps in all cases. The 100 % technical success was matched by a 95 % clinical success rate. We recorded 11 adverse events (23 %): five hemorrhages, four pancreatitis, and two cholangitis. In addition to the objective data, we confirmed that HT facilitates alignment with the duodenal papilla and the execution of pre-cutting, especially if the papilla is intradiverticular or hidden by folds. Conclusions The HT tested seems to help trained endoscopists to perform NKP, especially in some anatomic situations, which can improve compliance with the guidelines recommended for early NKP in patients with DBC.

Erradicación de la infección por Helicobacter pylori con una nueva terapia cuádruple basada en bismuto en la práctica clínica / Eradication of Helicobacter pylori infection with a new bismuth-based quadruple therapy in clinical practice

Introducción: La erradicación de la infección por Helicobacter pylori representa un desafío clínico. Objetivo: Evaluar la eficacia y seguridad de la terapia cuádruple con esomeprazol más una cápsula 3 en 1 que contiene subcitrato de bismuto, metronidazol y tetraciclina, más probióticos en pacientes diagnosticados de infección por H. pylori en la práctica clínica habitual. Métodos: Estudio prospectivo, intervencional, unicéntrico y abierto realizado en pacientes consecutivos con indicación confirmada de erradicación de infección por H. pylori. Los pacientes fueron tratados con 3 cápsulas de Pylera(R) 4veces al día (desayuno, comida, merienda y cena), más 40mg de esomeprazol, 2veces al día durante 10días (30min antes de desayuno y cena) y probióticos durante 30días. La erradicación de la infección por H. pylori se confirmó mediante la prueba del aliento con urea marcada realizada al menos 28días después del final del tratamiento. Resultados: Un total de 100 pacientes fueron incluidos consecutivamente. Veinticinco (25,0%) pacientes tenían historia previa de tratamiento de su infección por H. pylori. En la población por intención de tratar, las tasas de erradicación fueron del 90,7% (68/75) y del 80,0% (20/25) en los pacientes tratados con Pylera(R) como primera línea o como terapia de rescate, respectivamente. Dieciocho pacientes (18%) presentaron, al menos, un acontecimiento adverso, la mayoría (89%) leves. Conclusión: Diez días de tratamiento con un régimen cuádruple de bismuto, metronidazol y tetraciclina más esomeprazol y probióticos es una estrategia eficaz y segura en pacientes con infección por H. pylori (AU)

Introduction: The eradication of Helicobacter pylori infection represents a clinical challenge. Objective: To evaluate the efficacy and safety of quadruple therapy with esomeprazole plus a 3-in-1 capsule containing bismuth subcitrate, metronidazole and tetracycline, plus probiotics in patients diagnosed with H. pylori infection in routine clinical practice. Methods: A prospective, interventional, single-centre and open-label study in consecutive patients with a confirmed indication for eradication of H. pylori infection. Patients were treated with three capsules of Pylera(R) four times a day (breakfast, lunch, afternoon snack and dinner), plus 40mg of esomeprazole twice daily for 10 days (30min before breakfast and dinner) and probiotics for 30 days. Eradication of H. pylori infection was confirmed by labelled urea breath test performed at least 28 days after the end of treatment. Results: A total of 100 patients were consecutively enrolled. Twenty-five patients (25.0%) had a prior history of treatment for their H. pylori infection. In the intention-to-treat population, eradication rates were 90.7% (68/75) and 80.0% (20/25) in patients treated with Pylera(R) as the first line or as rescue therapy, respectively. Eighteen patients (18%) had at least one adverse event, most of which (89%) were mild. Conclusion: Ten days of treatment with a quadruple regimen of bismuth, metronidazole and tetracycline plus esomeprazole and probiotics is an effective and safe strategy in patients with H. pyloriinfection (AU)

Eficacia de canulación biliar y riesgo de pancreatitis de dos técnicas de precorte empleadas de forma precoz / Biliary cannulation effectiveness and pancreatitis risk using two early precut techniques

Introducción: las técnicas de precorte permiten alcanzar tasas de canulación biliar próximas al 100% aunque pueden elevar el riesgo de complicaciones. Recientemente, el precorte de aguja precoz se ha demostrado seguro y se propone como recurso preventivo de pancreatitis en casos de canulación difícil. El objetivo del presente estudio es evaluar las tasas de canulación y pancreatitis de dos técnicas de precorte ejecutadas precozmente. Pacientes y método: estudio retrospectivo de las colangio- pancreatografías retrógradas endoscópicas (CPRE) realizadas entre 2013 y 2016. Se analiza la eficacia y seguridad de la canulación simple, del precorte de aguja y del precorte transpancreático. Resultados: de 503 CPRE analizables se obtuvo la canulación simple en 369 (73,4%). En 53 casos se realizó un precorte de aguja, con éxito en 51 (96,2%), y en 78 casos se realizó un precorte transpancreático, con éxito en 75 (96,2%). La tasa global de canulación fue del 98,4%. En total se registraron once pancreatitis (2,4%), seis (1,8%) en las canulaciones simples (dos graves y una fatal), cinco (6,3%) en los precortes transpancreáticos (dos graves) y cero en los precortes de aguja. En los pacientes sometidos a precorte se registraron siete perforaciones (dos graves) y siete hemorragias, siendo la tasa global de complicaciones del 14,4%. Conclusiones: el empleo complementario de ambas técnicas de precorte permite alcanzar una tasa de canulación biliar satisfactoria. No obstante, la tasa de pancreatitis y otras complicaciones graves del precorte transpancreático es superior a la del precorte de aguja, lo que aconseja modificar la indicación de cada técnica (AU)

Introduction: Precut techniques allow for successful biliary cannulation rates approaching 100% but there may be an associated increase in the risk of complications. Recently, early needle-knife precut has been shown to be a safe procedure and is now used as a pancreatitis prevention resource for difficult cannulation cases. The goal of the present study was to assess cannulation and pancreatitis rates using two early precut techniques. Patients and methods: This was a retrospective study of endoscopic retrograde cholangio-pancreatography (ERCP) procedures performed from 2013 to 2016. The efficacy and safety of simple cannulation, needle-knife precut and transpancreatic precut were assessed. Results: Simple cannulation was achieved in 369 (73.4%) of 503 evaluable ERCP procedures. Needle-knife precut was successful in 51 (96.2%) of 53 attempts and transpancreatic precut was successful in 75 (96.2%) of 78 attempts. The overall cannulation rate was 98.4%. There were eleven (2.4%) pancreatitis events, six (1.8%) with simple cannulation (two severe, one fatal), five (6.3%) with transpancreatic precut (two severe) and zero events with the needle-knife precut procedure. Among the patients undergoing the precut procedure, seven experienced perforations (two severe) and there were seven bleeding events. The overall complication rate was 14.4%. Conclusions: The complementary use of either precut technique provides a satisfactory biliary cannulation rate. However, the rates of pancreatitis and other severe complications are higher for transpancreatic versus needle-knife precut, therefore the indications for both techniques should be modified (AU)

Biliary cannulation effectiveness and pancreatitis risk using two early precut techniques.

INTRODUCTION: Precut techniques allow for successful biliary cannulation rates approaching 100% but there may be an associated increase in the risk of complications. Recently, early needle-knife precut has been shown to be a safe procedure and is now used as a pancreatitis prevention resource for difficult cannulation cases. The goal of the present study was to assess cannulation and pancreatitis rates using two early precut techniques. PATIENTS AND METHODS: This was a retrospective study of endoscopic retrograde cholangio-pancreatography (ERCP) procedures performed from 2013 to 2016. The efficacy and safety of simple cannulation, needle-knife precut and transpancreatic precut were assessed. RESULTS: Simple cannulation was achieved in 369 (73.4%) of 503 evaluable ERCP procedures. Needle-knife precut was successful in 51 (96.2%) of 53 attempts and transpancreatic precut was successful in 75 (96.2%) of 78 attempts. The overall cannulation rate was 98.4%. There were eleven (2.4%) pancreatitis events, six (1.8%) with simple cannulation (two severe, one fatal), five (6.3%) with transpancreatic precut (two severe) and zero events with the needle-knife precut procedure. Among the patients undergoing the precut procedure, seven experienced perforations (two severe) and there were seven bleeding events. The overall complication rate was 14.4%. CONCLUSIONS: The complementary use of either precut technique provides a satisfactory biliary cannulation rate. However, the rates of pancreatitis and other severe complications are higher for transpancreatic versus needle-knife precut, therefore the indications for both techniques should be modified.

Eradication of Helicobacter pylori infection with a new bismuth-based quadruple therapy in clinical practice. / Erradicación de la infección por Helicobacter pylori con una nueva terapia cuádruple basada en bismuto en la práctica clínica.

INTRODUCTION: The eradication of Helicobacter pylori infection represents a clinical challenge. OBJECTIVE: To evaluate the efficacy and safety of quadruple therapy with esomeprazole plus a 3-in-1 capsule containing bismuth subcitrate, metronidazole and tetracycline, plus probiotics in patients diagnosed with H. pylori infection in routine clinical practice. METHODS: A prospective, interventional, single-centre and open-label study in consecutive patients with a confirmed indication for eradication of H. pylori infection. Patients were treated with three capsules of Pylera® four times a day (breakfast, lunch, afternoon snack and dinner), plus 40mg of esomeprazole twice daily for 10 days (30min before breakfast and dinner) and probiotics for 30 days. Eradication of H. pylori infection was confirmed by labelled urea breath test performed at least 28 days after the end of treatment. RESULTS: A total of 100 patients were consecutively enrolled. Twenty-five patients (25.0%) had a prior history of treatment for their H. pylori infection. In the intention-to-treat population, eradication rates were 90.7% (68/75) and 80.0% (20/25) in patients treated with Pylera® as the first line or as rescue therapy, respectively. Eighteen patients (18%) had at least one adverse event, most of which (89%) were mild. CONCLUSION: Ten days of treatment with a quadruple regimen of bismuth, metronidazole and tetracycline plus esomeprazole and probiotics is an effective and safe strategy in patients with H. pylori infection.