ABSTRACT
BACKGROUND: Colonoscopy procedures are commonly performed and have high success rates. However, poor or inadequate bowel preparation is one of the most common reasons for a repeated or failed colonoscopy. We therefore performed an observational study followed by propensity score modeling to evaluate and compare the quality of bowel preparation with the use of Aquanet bowel cleansing devices (BCDs) versus the use of oral sodium picosulfate solution. METHODS: We performed a prospective cross-sectional study to compare the quality of pre-endoscopic bowel preparation using a BCD with oral solution. Our major outcome of interest was the quality of bowel preparation as measured through the Boston bowel preparation (BBP) scale. Our main predictor was the method of bowel preparation. The bowel was prepared using either sodium picosulfate or the BCD. RESULTS: A total of 314 participants were part of this study. The average age of the participants was 54 years and most of the participants were females (81%). Sodium picosulfate was associated with better scores at each segment. After propensity scoring with a 1:1 match and further adjusting for the unbalanced variable (age), we found that despite the apparent superior cleansing performance of sodium picosulfate over the BCD, the difference was not statistically significant. CONCLUSION: This study reinforces previous reports regarding the quality, safety and comfort of BCDs, indicating that this technique should be considered for colonoscopy preparation. In the future, randomized controlled trials should be performed to validate these preliminary findings.
ABSTRACT
OBJECTIVE: to evaluate the effect of sphincter defect (SD) on biofeedback (BF) response in patients with fecal incontinence. METHODS: two hundred and forty-two patients with fecal incontinence undergoing BF as exclusive treatment were identified from a BF database. Patients were evaluated with fecal incontinence score (Cleveland Clinic Florida - Fecal Incontinence Score, CCF-FI) and anorectal physiology tests. The pre- and immediate post-treatment outcomes were obtained from the chart, and the long-term outcomes by CCF-FI score that was sent by mail. RESULTS: 242 patients underwent BF for fecal incontinence. 143 (59.1%) underwent ultrasonography, 43 (30.1%) of whom had sphincter defect detected on US. The immediate outcomes were not affected by the presence of absence of SD. The second CCF-FI questionnaire was mailed after a mean of 6.1 years after treatment. 31 (57.4%) exhibited improvement, 4 (7.4%) remained unchanged, and 19 (35.2%) had worsening function, which was significantly inferior in patients with SD (p = 0.021). Electromyography demonstrated increased electrical activity in the contraction phase after BF in both groups. CONCLUSIONS: the majority of patients experience improvement in fecal incontinence after BF. However, patients with SD detected on US prior to treatment seem to have worse function at long term. (AU)
OBJETIVOS: avaliar a influência do defeito esfincteriano (DE) na resposta ao biofeedback (BF) em pacientes com incontinência fecal. MÉTODOS: 242 pacientes com incontinência fecal, submetidos exclusivamente ao BF como forma de tratamento, foram selecionados. Os pacientes foram submetidos ao escore de incontinência fecal (Cleveland Clinic Flórida-Escore de Incontinência Fecal, CCF-IF) e testes de investigação da fisiologia anorretal. O pré e pós-tratamento imediato foram obtidos do prontuário e para avaliação a longo prazo foi enviado o CCF-IF pelo correio. RESULTADOS: 242 pacientes realizaram BF. 143 (59,1%) realizaram ultrassom e em 43 (30,1%) foi evidenciado DE. Os resultados imediatamente após o BF não foram afetados pela presença ou ausência de DE. O segundo questionário foi enviado pelo correio com tempo médio de 6,1 anos após término do BF. 31 (57,4%) melhoraram, 4 (7,4%) permaneceram inalterados e 19 (35,2%) pioraram, mas nos pacientes com DE a melhora foi significativamente inferior (p = 0,021). A eletromiografia demonstrou melhora na atividade elétrica na fase de contração em ambos os grupos. CONCLUSÕES: houve melhora clínica na maioria dos pacientes com incontinência fecal após o BF. Entretanto, pacientes com DE detectados ao US antes do tratamento, apresentaram piores resultados a longo prazo. (AU)
Subject(s)
Humans , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Anal Canal/physiopathology , Biofeedback, Psychology , Fecal Incontinence , Ultrasonics , Electromyography , ManometryABSTRACT
Torocobilia (TcB), seja sob a forma de Biliotórax (BT) e/ou Fístula Bronco - Biliar (FBB) tem sido descritacomo consequência de complicações de várias doenças, que incluem os abscessos sucfrênicos ou hepáticos, obstrução supurativa dos ductos biliares e estenoses pós-operatórios dos mesmos, drenagens biliares per-cutâneas, neoplasias e trauma da região tóraco abdominal. Os autores descrevem um caso de BT, comentam com revisão da literatura e descrevem a conduta terapêutica empregada nessa situação singular de traumatismo
