Single-center experience with intraprocedural cleansing system to improve inadequate bowel preparation during colonoscopy.

Inadequate bowel preparation is common despite various preprocedure interventions. There is a need for an intervention at the time of colonoscopy to combat poor preparation. In this retrospective, observational study of 46 patients, we evaluated the clinical efficacy and feasibility of implementing the third generation of the Pure-Vu EVS System, a US Food and Drug Administration-cleared over-the-scope-based intraprocedural cleansing device, into our practice at the Minneapolis VA Medical Center (Minneapolis, Minnesota, United States). To study clinical efficacy, we measured bowel preparation adequacy before and after using the device, as measured by the Boston Bowel Preparation Score, and reviewed colonoscopy surveillance interval recommendations. Technical success and feasibility of using the device were measured by procedure success rates and duration. We found that BBPS scores increased from 4.4 to 7.9 when using the device. Technical success was achieved 78.3% of the time (36/46 cases). Median colonoscopy duration was 46 minutes, although there was a trend toward shorter procedures over time. This is the first clinical evaluation of the third generation of an intraprocedural cleansing device. We found the device efficacious and easy to use with low procedure failure rates, but it does come with a learning curve. We suspect that adoption of this device mutually will benefit patients and health systems with the potential to improve resource utilization.

A Novel Text Message Protocol to Improve Bowel Preparation for Outpatient Colonoscopies in Veterans.

Background: The current gold standard for screening for colorectal cancer is colonoscopy, a procedure that depends on the quality of bowel preparation. In 2016, the Veterans Health Administration introduced Annie, a text message service to improve health care communication with patients. The Minneapolis Veterans Affairs Medical Center conducted a prospective, single center study to measure the impact of Annie text messaging on patient satisfaction and quality of bowel preparation for patients undergoing outpatient colonoscopy. Methods: Patients undergoing colonoscopy were divided into 2 groups. The control group received standardized patient education and a phone call prior to procedure. The intervention group, consisting of all patients who agreed to enroll, received a 6-day Annie text messaging protocol consisting of key bowel preparation steps that started 5 days prior to their scheduled procedure. Bowel preparation quality was measured using the Boston Bowel Preparation Scale (BBPS) score. Results: During the study period, 688 veterans were scheduled for outpatient colonoscopy: 484 veterans were in the control group, 204 veterans were in the intervention group, and 126 were surveyed. Annie text messaging instructions were associated with a higher BBPS score (8.2) compared with usual care (7.8); P = .007 using independent t test, and P = .002 using parametric independent t test. Patients also reported satisfaction with the Annie text messaging service. Conclusions: There was a statistically significant improvement in the average BBPS score in veterans receiving Annie text messages compared with the routine care control group for outpatient colonoscopies.

Noninvasive strategies for colorectal cancer screening: opportunities and limitations.

PURPOSE OF REVIEW: In the United States, only 67% of patients are up to date with colorectal cancer (CRC) screening. While colonoscopy is highly sensitive and specific for CRC and precursor lesion detection and removal, it is invasive, expensive and resource heavy. Hence, there is an unfulfilled need for multiple modality CRC screening that can improve current CRC screening rates and may be resource effective strategies when used in conjunction with a colonoscopy program. Our review highlights the complementary, often underutilized, noninvasive CRC screening methods with a focus on performance, risks, benefits, and recent updates. RECENT FINDINGS: Studies demonstrate that fecal immunochemical testing (FIT) is superior to guaiac-based fecal occult blood tests for CRC screening. Studies show superiority of multitarget stool DNA test to FIT in sensitivity, though with concern for decreased specificity in setting of one-time tests. Technical advances continue to improve accuracy of colon capsule endoscopy. There are ongoing studies to characterize often difficult-to-detect high-risk lesions in computed tomography colonography. Septin 9 continues to have suboptimal accuracy for CRC screening, but has been shown to be associated with more advanced, invasive CRC stages. SUMMARY: There are ongoing advances in noninvasive screening modalities for CRC; these should be considered as alternatives to colonoscopy in specific patient populations.

Small intestinal bacterial overgrowth and nonalcoholic fatty liver disease: a systematic review and meta-analysis.

OBJECTIVES: Recent studies have suggested that small intestinal bacterial overgrowth (SIBO) could be a predisposing factor for nonalcoholic fatty liver disease (NAFLD) although the results were inconsistent. This systematic review and meta-analysis was conducted with the aim to summarize all available data. METHODS: A comprehensive literature review was conducted utilizing MEDLINE and EMBASE databases through September 2018 to identify all studies that compared the risk of NAFLD among patients with SIBO versus those without SIBO. Effect estimates from each study were extracted and combined together using the random effect, generic inverse variance method of DerSimonian and Laird. RESULTS: A total of 10 studies with 1093 participants fulfilled the eligibility criteria and were included in the meta-analysis. A significant association between NAFLD and SIBO was observed with the pooled odds ratio of 3.82 (95% confidence interval, 1.93-7.59; I 65%). Funnel plot is relatively symmetric and is not suggestive of the presence of publication bias. CONCLUSION: A significant association between NAFLD and SIBO was observed in this meta-analysis.

Nonalcoholic Fatty Liver Disease and Urolithiasis. A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Recent studies have suggested that nonalcoholic fatty liver disease (NAFLD) could be a predisposing factor for urolithiasis but the results have been inconsistent. This systematic review and meta-analysis was conducted with the aim to summarize all available data. METHODS: A comprehensive literature review was conducted using MEDLINE and EMBASE databases through March 2018 to identify all studies that compared the risk of urolithiasis among patients with NAFLD versus those without NAFLD. Effect estimates from each study were extracted and combined together using the random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: A total of eight studies with 238,400 participants fulfilled the eligibility criteria and were included in the meta-analysis. The risk of urolithiasis among patients with NAFLD was significantly higher than in those without NAFLD with a pooled odds ratio of 1.81 (95% confidence interval, 1.29-2.56; I2 92%). CONCLUSIONS: A significantly increased risk of urolithiasis among patients with NAFLD was observed in this meta-analysis.

Cigarette smoking and risk of celiac disease: A systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: A negative association between cigarette smoking and celiac disease has been observed but results were inconsistent across the published studies. A meta-analysis was conducted with the aim to identify all studies that investigated this association and to summarize the results of those studies. METHODS: A comprehensive literature review was conducted utilizing MEDLINE and Embase databases through March 2018 to identify all cohort studies and case-control studies that compared the risk of celiac disease among current and/or former smokers versus never-smokers. Effect estimates from each study were extracted and combined together using the random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: A total of seven studies with 307,924 participants fulfilled the eligibility criteria and were included in the meta-analysis. The pooled analysis found a significantly decreased risk of celiac disease among current smokers compared with never-smokers with the pooled odds ratio (OR) of 0.52 (95% confidence interval (CI), 0.32-0.84; I2 86%). However, the risk of celiac disease among former smokers was not significantly different from never-smokers with the pooled OR of 1.10 (95% CI, 0.76-1.60; I2 of 73%). CONCLUSIONS: A significantly decreased risk of celiac disease among current smokers compared with never-smokers was demonstrated in this meta-analysis.

Association between diastolic cardiac dysfunction and nonalcoholic fatty liver disease: A systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: Recent studies have suggested an association between nonalcoholic fatty liver disease (NAFLD) and diastolic cardiac dysfunction, although the results were inconsistent. This study was conducted to investigate this possible association. METHODS: A comprehensive literature review was conducted utilizing the MEDLINE and Embase databases from inception through May 2018 to identify all cross-sectional studies that compared the prevalence of diastolic cardiac dysfunction among patients with NAFLD to individuals without NAFLD. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: A total of 12 studies with 280,645 participants fulfilled the eligibility criteria and were included in the meta-analysis. There was a significant association between NAFLD and diastolic cardiac dysfunction with a pooled odds ratio (OR) of 2.02 (95% confidence interval (CI), 1.47-2.79; I2 89%). Subgroup analysis based on the country of origin continued to demonstrate a significant association in subgroups of both Western and Eastern countries with pooled ORs of 1.76 (95% CI, 1.14-2.72; I2 85%) and 2.59 (95% CI, 1.42-4.69; I2 87%), respectively. Limitations included high between-study heterogeneity, lack of unified definition of diastolic dysfunction and presence of publication bias. CONCLUSIONS: A significant association between diastolic cardiac dysfunction and NAFLD was observed in this meta-analysis. This observation could suggest the need for careful cardiovascular surveillance among patients with NAFLD.

Diagnosis and treatment for ocular tuberculosis among uveitis specialists: the international perspective.

PURPOSE: To assess the approach of international specialists, who primarily practice in tuberculosis-endemic areas, to ocular tuberculosis (TB). METHODS: International experts from India, Brazil, Taiwan, and more than 10 other countries were surveyed using two clinical cases and general questions. RESULTS: A total of 244 experts were sent a survey about the treatment and diagnosis of ocular tuberculosis; 65 responded (27%), of whom 34 were affiliated with practices in India, while 31 primarily practice at international sites outside of India and North America. The data from this survey were compared with the results of a similar survey sent to members of the American Uveitis Society. The survey provided normative data on how physicians evaluate patients with uveitis as well as opinions about ocular TB. Responses varied widely on topics such as tests to include in the workup of undifferentiated uveitis, initial therapy, and duration of treatment. Physicians from developing countries relied more on chest CT scans and tuberculin skin testing (TST) than their counterparts in developed countries. CONCLUSIONS: The approach to diagnosis and management of TB is heterogeneous worldwide. However, there are substantial differences in the clinical approach to uveitis depending on the clinician's location of practice.

Lack of consensus in the diagnosis and treatment for ocular tuberculosis among uveitis specialists.

PURPOSE: To assess the approach of specialists to ocular tuberculosis (TB). METHODS: The American Uveitis Society (AUS) Listserv was surveyed using two clinical cases and general questions. RESULTS: Of 196 members, 87 responded (44.4%), of whom 64 were affiliated with practices in North America, while 23 were outside of North America. The survey provided normative data on how physicians evaluate patients with uveitis as well as opinions about ocular TB. Responses varied widely on such issues as (1) the pretest probability that a patient with granulomatous panuveitis had TB uveitis (range 1-75%) or that a patient with a risk factor for TB had ocular TB (range 0-90%); (2) the optimal duration of anti-TB therapy; and (3) whether therapy should be discontinued after 2 months in nonresponders. CONCLUSIONS: Consensus is lacking among uveitis specialists for the diagnosis or management of ocular TB.