Comparison of patterns of laxative ingestion to improve bowel preparation for colonoscopy: a pilot randomized clinical trial.

Background and study aims Negative experiences with bowel preparation are a barrier to uptake of colonoscopy. The aim of this study was to examine the impact of different flavoring of polyethylene glycol (PEG) laxatives on patient satisfaction with and adequacy of bowel preparation during colonoscopy. Patients and methods This was a single-blind (endoscopist), parallel design, randomized trial (NCT02062112) during which patients scheduled for colonoscopy were assigned to one of three groups: Group 1 (no laxative flavoring, n = 84); Group 2 (flavored entire laxative, n = 90) and Group 3 (tasted PEG with and without flavoring and decided how they want to drink the rest of the laxatives (choice group), n = 82). Patients rated their bowel preparation experience (satisfaction) and endoscopists accessed adequacy of bowel preparation during colonoscopy. Results There were no differences in patient ratings across the groups (1, 2 and 3) in taste of the laxatives ( P  = 0.67), ease of drinking ( P  = 0.53), and overall experience of bowel preparation process ( P  = 0.18). However, higher percentage of patients in the choice group would want the same laxative again if they were going to have a repeat colonoscopy in the future (72.5 % vs 81.3 % vs 88.9 %, P  = 0.04). Surprisingly, adequacy of bowel preparation was highest among patients who drank their PEG unflavored (89.3 % vs 80 % vs 75.5 %, P  = 0.07) and the had highest rates of adenoma detection (40.5 % vs 23.3 vs 39.0, P  = 0.03). Conclusions There were no differences in overall tolerability of bowel preparation by patterns of flavoring of PEG. Those who drank unflavored PEG were less satisfied but had better clinical outcome, suggesting minimum justification effect in bowel preparation process.

Using Patients' Social Network to Improve Compliance to Outpatient Screening Colonoscopy Appointments Among Blacks: A Randomized Clinical Trial.

OBJECTIVES: Patient navigation improves colorectal cancer screening among underserved populations, but limited resources preclude widespread adoption in minority-serving institutions. We evaluated whether a patient's self-selected social contact person can effectively facilitate outpatient screening colonoscopy. METHODS: From September 2014 to March 2017 in an urban tertiary center, 399 black participants scheduled for outpatient screening colonoscopy self-selected a social contact person to be a facilitator and provided the person's phone number. Of these, 201 participants (50.4%) were randomly assigned to the intervention arm for their social contact persons to be engaged by phone. The study was explained to the social contact person with details about colonoscopy screening and bowel preparation process. The social contacts were asked to assist the participants, provide support, and encourage compliance with the procedures. The social contact person was not contacted in the usual care arm, n = 198 (49.6%). We evaluated attendance to the scheduled outpatient colonoscopy and adequacy of bowel preparation. Analysis was performed by intention to treat. RESULTS: The social contact person was reached and agreed to be involved for 130 of the 201 participants (64.7%). No differences were found in the proportion of participants who underwent screening colonoscopy (77.3% vs 77.2%; relative risk = 1.01; 95% confidence interval: 0.91-1.12), but there was a modest increase in the proportion with adequate bowel preparation with social contact involvement (89.1% vs 80.9%; relative risk = 1.10; 95% confidence interval: 1.00-1.21). DISCUSSION: Engaging a patient's social network to serve in the role of a patient navigator did not improve compliance to outpatient screening colonoscopy but modestly improved the adequacy of bowel preparation.

Timing of procedure and compliance with outpatient endoscopy among an underserved population in an inner-city tertiary institution.

PURPOSE: Anecdotal evidence suggests that patient compliance with colonoscopy is poorer with Monday procedures and better during the winter months because "there is not much else to do." We examined patients' compliance with scheduled outpatient endoscopy by time of the day, days of the week, and seasons of the year. METHODS: We included 2873 patients who were scheduled for endoscopy from September 2009 to August 2010. Compliant patients were those who showed up for their procedures whereas noncompliant patients were those who did not show up without canceling or rescheduling their procedures up to 24 hours before their scheduled procedures. We used logistic regression models to evaluate the association between the timing of the scheduled procedure and compliance. RESULTS: A total of 574 (20%) patients did not show up. There was no difference in compliance by time of day of the procedures. However, when compared with patients scheduled for procedures on Monday, there was a trend towards improved compliance as the week progressed, becoming significant on Friday (odds ratio 1.46; 95% confidence interval 1.06-2.00). There was also better compliance in the warmer months. CONCLUSIONS: Noncompliance with outpatient endoscopy is substantial among underserved populations with limited predictive pattern of compliance by the timing of the procedures.

Upper gastrointestinal bleeding from metastatic testicular cancer.

We report a 22-year-old man who presented with a 2-week history of intermittent melena and worsening scrotal and leg swelling. His medical history was significant for testicular cancer for which he had undergone orchiectomy, lymphadenectomy, and platinum-based chemotherapy. Esophagogastroduodenoscopy (EGD) performed revealed polypoid mass lesions in the second and third portions of the duodenum. Biopsy revealed mixed germ cell tumor with immature teratoma, the same histology as his testicular cancer. His chemotherapy was changed to an ifosphamide-based regimen and a repeat upper endoscopic examination 5 months later revealed complete resolution of previously noted polypoid duodenal mass lesions. This also demonstrates the effectiveness of ifosphamide as second-line therapy in the setting of resistance to platinum-based therapy.

Ideology of Helicobacter pylori prevalence in peptic ulcer disease in an inner-city minority population.

GOALS AND BACKGROUND: The prevalence of Helicobacter pylori infection among patients with peptic ulcer disease has been reported to range from 61 to 94%. Recent studies show a reduction in the prevalence of H. pylori infection in patients with peptic ulcer disease. This study was conducted to determine the prevalence of H. pylori infection in peptic ulcer disease in an inner-city hospital in Washington, DC. METHODS: Medical records of all patients who had undergone upper gastrointestinal endoscopy from July 1997 through June 1999 were reviewed. All patients who had gastric ulcer and/or duodenal ulcer on upper gastrointestinal endoscopy were studied. Demographic characteristics, history of nonsteroidal antiinflammatory drug ingestion, alcohol consumption, and associated diseases were studied. H. pylori was considered to be present if CLOtest and/or histopathology were positive for H. pylori. Patients with negative pathology for H. pylori or negative pathology and CLOtest were considered negative for H. pylori. RESULTS: One-hundred fifty-six patients were found to have gastric and/or duodenal ulcers. Fifty-one ulcer patients did not meet the inclusion criteria and were excluded. Among the 105 patients who were included in the study, gastric ulcers were found in 48 patients (45.7%), duodenal ulcers were found in 46 patients (43.8%), and both gastric and duodenal ulcers were found in 11 patients (10.5%). H. pylori was present in 66.7% of gastric ulcer patients and in 69.5% of duodenal ulcer patients. Antral histology and CLOtest were in agreement 96% of the time. CONCLUSIONS: At the District of Columbia General Hospital, an inner-city hospital serving predominantly an African-American community, the prevalence of H. pylori in ulcer patients compares similarly to other more recent studies that have found a decreased prevalence of this bacterial infection in ulcer patients. This suggests that the treatment of H. pylori in minority patients is reducing the proportion of ulcers due to this bacterium, as has been seen with the majority population.

Advanced gastrointestinal stromal tumors successfully treated with imatinib mesylate: a report of two cases.

Activation of kit-receptor tyrosine kinase occurs in all cases of gastrointestinal stromal tumors, regardless of the mutation status of kit. Imatinib mesylate (STI 571,Gleevec) is a selective inhibitor of certain protein tyrosine kinases. It has been shown in preclinical models and clinical studies to have activity against such tumors. The aim of the present study was to report the efficacy of imatinib mesylate in the treatment of advanced gastrointestinal stromal tumors. Two adults with histologically confirmed, unresectable, and metastatic gastrointestinal stromal tumors that expressed CD117 (a marker of kit-receptor tyrosine kinase) were identified at our institution during 2000-2002. As the diseases were advanced and not amenable to surgery, chemotherapy, or radiation therapy, imatinib mesylate was used, because this targeted inhibitor has been shown to be active against advanced gastrointestinal stromal tumors and has a mild toxicity profile. Imatinib mesylate induced a sustained response in both patients with advanced unresectable or metastatic gastrointestinal stromal tumors. Inhibition of the KIT signal-transduction pathway is a promising treatment for advanced gastrointestinal stromal tumors, which resist conventional chemotherapy.