[Factors related to a suboptimal bowel preparation for colonoscopy]. / Factores relacionados a una subóptima preparación intestinal para la colonoscopía.

INTRODUCTION: Colonoscopy is the standard method for the evaluation of the colon. A suitable intestinal cleaning is critical for the effectiveness and security of the procedure, but unfortunately there is a high proportion of suboptimal bowel preparation. OBJECTIVE: To identify factors related to suboptimal bowel preparation. METHODS: We performed an analytic, observational, cross-sectional and prospective study. We included all outpatients scheduled for colonoscopy in the Peruvian-Japanese Health Center between January and July 2012. We excluded patients with a complete or partial colonic resection. In patients with two or more colonoscopies during the study interval, only the first procedure was considered. Aronchick scale was used in assessment of bowel cleaning. The variables studied with relationship to bowel preparation were: age, sex, grade ofeducation, body mass index, time of examination, history (diabetes mellitus, stroke, cirrhosis, use of antidepressants/anxiolytics, number of bowel movements per week, abdominal surgery, personal history of previous colonoscopy, polyps and colon cancer, family history of colon cancer), received purgative, additional laxative, indication for colonoscopy and adverse effects of the preparation. Statistical analysis was made with SPSS v.160. For the categorical variables we used chi square test or Fisher exact test, whereas for continuous variables the Mann Whitney test was used. The variables significantly associated with suboptimal preparation in the univariated analysis were included in a multivariate analysis using logistic regression. RESULTS: We included 841 patients. The bowel preparation was suboptimal in 438 patients (52.1%). The univariate analysis showed that the factors related to suboptimal preparation were age (P = 0.023) and body mass index ≥ 30 kg/m2 (P = 0.021). The multivariate analysis confirmed that age ≥ 70 years old (P = 0.001) and body mass index ≥ 30 kg/m2 (P = 0.010) were the variables related to suboptimal bowel preparation. CONCLUSIONS: Age greater than 70 years old and obesity are factors related to suboptimal bowel preparation.

Dinámica y eficacia de la preparación con manitol y bisacodilo para colonoscopía / Dynamics and efficacy of the preparation with mannitol and bisacodyl for colonoscopy

El uso de manitol al 10% es el método de preparación para colonoscopia más utilizado en Brasil, donde se siguió utilizando pese a los riesgos potenciales deexplosión, donde ha demostrado su se guridad en las últimas dos décadas. Es una opción de preparación para colonoscopia, sobretodo si no se cuenta con polietilenglicol o fosfosoda (Flete phosphosoda TM). El objetivo de este estudio es evaluar la eficacia, efectos adversos y dinámica de esta forma de limpieza colónica. PACIENTESY METODOS: Se estudiaron prospectivamente 64 pacientes, en quienes estaba indicada una colonoscopia electiva. Recibieron dos comprimidos de bisacodilo y un litro de manitol al 10%. La preparación fue supervisada por personal de enfermería. RESULTADOS: En promedio la primera evacuación fue a los 43.4 minutos, el número total de evacuaciones fue ocho y el tiempo total fue de 162 minutos. En la mayoría de pacientes la preparación transcurrió sin mayores incomodidades. La preparación se consideró excelente o buena en 84.4%, regular en 12.5% y mala en 3.1% de los pacientes. Se realizaron quince resecciones con electrocauterio. CONCLUSIONES: La limpieza del colon con bisacodillo y manitoles efectiva, segura y bien tolerada. El manitol es fácil de beber y de buen sabor. La limpieza colónica es más rápida comparada con otras sustancias.

The use of mannitol 10% is the preferred method of colonic cleansing used in Brazil, where it’s use continue in spite of the potencial risk of explosion, having demonstrate it's safety in the last two decades. It’s a colonic cleaning choice, evermore if poliethilenglicol or phospho-soda are not reachable. The objective of this study is to evaluate the effectiveness, adverse effects and dynamic of this type of substance. PATIENTS AND METHODS: We study prospectively 64 patients, in whom an elective colonoscopy was indicated. The patients received two tablets of bisacodil and one liter of mannitol 10%. The preparation was supervised with the nursery staff. RESULTS: In average, the first intestinal movement was at 43.4 minutes, the total bowel movements were eighth and the total time to complete the cleaning was 162 minutes. In most of the patients, there were not problems during the preparation. The preparation was considered excellent or good in 84.4%, fair in 12.5% and poor in 3.1% of the patients. 15 resections with electrocautery were performed. CONCLUSIONS:The cleaning of colon with bisacodil and mannitolis effective, safe and well tolerated. Mannitol is easy to drink and has good taste. The colonic cleaning is quicker than with other substances.

Minilazo hemostático de polipectomía en enfermedad de von Willebrand / Polypectomy Minilazo hemostatic von Willebrand disease

Presentamos la historia clínica de un paciente de 52 años, portador de Enfermedad de von Willebrand, hospitalizado por un cuadro de hemorragia digestiva baja, que cedió espontáneamente. En la colonoscopia se detectó en sigmoides una lesión elevada grande con pedículo grueso. Tres horas antes de la polipectomía se le transfundió 6 unidades de crioprecipitado, además recibió ácido tranexámico por vía oral; por seguridad se decidió usar un minilazo (endo-loop) oval denylon, que se ajustó en la base del pedículo, y por encima se realizó el corte con asa de alambre y equipo de electrocoagulación. La evolución fue buena, no presentó ninguna complicación.

We report a 52 year-old man with von Willebrand disease and lower digestive hemorrhage secondary to large pedunculated polyp in the sigmoid color. He gave tranexamic acid and transfusion of 6 units of cryoprecipitate three hours before the polypectomy. We used a detachable snare (nylon end-loop) that allowed endoscopic ligation of the stalk of a large pedunculated polyp. A diathermic snare was then used to sever the stalk of the polyp above the tightened loop. No bleeding occurred during or after proceeding. The mini-detachable snare is a device that provides safe and effective hemostasis during removal of large polyps.

Extracción de pólipos pediculados grandes utilizando una asa de nylon para la prevención del sangrado post-polipectomía / Removal of large pedunculated polyps using a nylon loop for preventing post-polypectomy bleeding

La complicación más frecuente de la extracción endoscópica de pólipos es la hemorragia luego del procedimiento. El riesgo es mayor cuando se trata de pólipos pediculados grandes. Existe controversia en cuanto a la magnitud de este riesgo con diversos estudios. Existe consenso que en pacientes con coagulopatia, o en uso de AINES, aspirina o anticoagulantes sería necesario realizar algún procedimiento preventivo. El objetivo es describir una nueva técnica para disminuir el riesgo de esta complicación utilizando una asa de nylon artesanal previa a la polipectomía convencional. Este procedimiento se realizó en catorce pacientes con pólipos pediculados grandes de 3.2 cm de diámetro en promedio. Se logró enlazar todos los pólipos, no hubo ninguna complicación secundaria al procedimiento y no hubo ningún caso de sangrado inmediato o tardío. Se compara las ventajas de esta técnica con las descritas anteriormente con éxito. CONCLUSION: El uso de esta asa de nylon como método para prevenir el sangrado post-polipectomía es efectivo, sin riesgos adicionales para el paciente, de fácil uso y bajo costo.

The most common complication of the endoscopic extraction of peduncalated polyps is the post-procedure bleeding. The risk is greater in large pedunculated polyps. There is controversy about the risk’s amount in the published reports. There is consensus that in patients with coagulpathy or in use of NSAIDS, aspirin or warfarin is necessary the use of a preventive hemostatic method. The aim is to describe a new technique for lowering the risk of this complication using a home-made nylon loop before a conventional polypectomy. This procedure was used in 14 patients with large pedunculated polyps, with 3.2 cm of mean diameter. It was possible to snare all the polyps, there were not complications with the use of the nylon loop and there weren’t immediate or delayed bleeding. The advantages of this technique are discussing, comparing with other preventive hemostatic techniques. CONCLUSIONS: The use of this nylon loop in order to prevent post-polypectomy bleeding is effective, without additional risks, easy to use and low cost.