Position change during colonoscopy improves caecal intubation rate, mucosal visibility, and adenoma detection in patients with suboptimal caecal preparation.

INTRODUCTION: Most colonoscopies are completed in the left lateral (LL) position but in cases of suboptimal caecal preparation, changing the patient's position to supine (S) and, if needed, to right lateral (RL) improves caecal intubation rate, mucosal visibility, and adenoma detection. AIM: To determine if position change during colonoscopy facilitates optimal visualisation of the caecum. MATERIAL AND METHODS: A total of 359 patients were grouped into three categories based on the initial caecal intubation position. After caecal intubation, caecal visibility was scored on a four-point scale depending on the number of imaginary quadrants of the caecum completely visualized - Arya Caecal Prep Score. A score of 1 or 2 was unsatisfactory, while 3 or 4 was considered satisfactory. In patients with unsatisfactory score, position was changed from LL to S and then RL and visibility was scored again. RESULTS: The initial caecal intubation in the LL position was achieved in 66.8% of patients, S in 28.5%, and RL in 4.8% of patients. 84.5% (300/355) of patients had an acceptable visualisation score at the initial caecal intubation position. Of the 55 patients with unsatisfactory caecum visualisation scores in the initial intubation position, 30 (8.5%) had satisfactory scores after the first position change (95% CI: 5.77-11.84). Twenty-five (7.04%) subjects required two position changes (95% CI: 4.61-10.22%). An additional 9.3% (11/118) of adenomas were detected in caecum and ascending colon following position change. CONCLUSIONS: Changing patient position improves caecal intubation rate, mucosal visibility, and adenoma detection.

Resolution of constipation, anal stricture, and iron deficiency anemia after iron infusion: an analogy with Plummer Vinson syndrome.

BACKGROUND: Anal stricture is a disabling condition which is often unresponsive to conservative medical management. The complications of surgical procedures such as dilatations and anoplasty make it a formidable treatment challenge. Through this case, we report and explore a new medical treatment for ano-rectal strictures with an analogy to Plummer Vinson syndrome. A 69-year-old male presented with chronic constipation, rectal pain, and easy fatigability. The physical exam was negative for anal fissure and a digital rectal examination could not be completed because an index finger could not be advanced through the narrowed anus. Laboratory reports revealed microcytic hypochromic anemia with iron deficiency. A colonoscopy performed with a GIF XQ180 OLYMPUS scope, confirmed anal stricture with non-specific colitis. Conservative management with laxatives, high fiber diet, local anesthetics with a trial of mesalamine was initiated but the patient continued to have symptoms. He was referred to a hematologist for an evaluation of anemia and was started on intravenous (IV) iron infusion. FINDINGS: The patient's symptoms of constipation, anal stricture and iron deficiency anemia resolved with iron infusion over 3 months. A repeat rectal exam was painless and confirmed resolution of anal stricture. CONCLUSION: IV iron supplementation combined with conventional anal dilatation presents as a promising approach toward the treatment of anal strictures.

Rapid colonoscopy preparation using bolus lukewarm saline combined with sequential posture changes: a randomized controlled trial.

OBJECTIVE: In this randomized clinical trial, we have compared the Shudh™ colon cleanse (SCC) with HalfLytely(®) colon prep (HCP) to evaluate the efficacy, bowel preparation time (BPT), adverse events, electrolyte abnormalities and patient acceptability. METHODS: Patients were randomized to receive either SCC (n = 65) or HCP (n = 68). All colonoscopies were performed by a single, blinded endoscopist. Colon prep was evaluated on a 5 point grading scale. Statistical non-inferiority was pre-defined as a difference of <15 % in the lower limit of the 95.5 % confidence interval for the treatment difference. Data that were collected include bowel prep score, BPT, adverse events, electrolyte abnormalities and patient acceptability. RESULTS: Bowel preparation efficacy was rated as "successful" for 59/65 (90.7 %) in SCC versus 66/68 (97.1 %) in HCP. This gave a success difference of -6.4 % with a 1-sided 95 % lower confidence limit (LCI) for the difference = -13.3 % (non-inferiority p = 0.25). This difference fell within the predefined limit for non-inferiority. The average BPT for SCC was 1.9 h versus 10.9 in HCP (p < 0.001). No serious adverse events were reported in either group. None of the patients in either group had any clinically significant electrolyte imbalance. Patient ratings for palatability and willingness to repeat were significantly better for SCC (p < 0.05). CONCLUSION: SCC was found to not be inferior to PEG with regards to the quality of bowel preparation. It is worth highlighting that a major advantage of SCC is shorter BPT.

Efficacy of bolus lukewarm saline and yoga postures as colonoscopy preparation: a pilot study.

BACKGROUND: Colonoscopy is now the gold standard for colon cancer screening and a vital diagnostic and therapeutic tool in 21st century medical practice. Although advances have been swift since colonoscopy came into wide use a generation ago, its effectiveness can be compromised by patients' ability to adequately prepare for the procedure. Many patients dread this task more than the procedure itself. While no prep regimen can be ideal for all patients, the authors present a novel approach that represents a potential time-saving improvement for younger, healthier patients. It is a modern version of an Indian practice called shankh prakshalana, in which lukewarm saline is used in combination with five yoga postures to cleanse the bowel. OBJECTIVE: The objective of this study was to examine the safety, efficacy, and tolerability of lukewarm saline and yoga (LWS/yoga) as a colonoscopy preparation in comparison with NuLytely(®) (PEG-3350, sodium chloride, sodium bicarbonate, and potassium chloride solution) used according to the manufacturer's instructions. RESEARCH DESIGN: This was a pilot study comprising 54 healthy adults, ages 18-65, equally divided into two groups: Group A preparing with lukewarm saline and yoga postures (LWS/yoga); and Group B preparing with NuLytely(®) as directed on the label. MEASUREMENTS: Data were collected on the quality of bowel preparation, patient safety, patient tolerability, and side-effects. The setting was a Joint Commission accredited outpatient endoscopy clinic. INTERVENTIONS: Patients performed the series of five yoga postures known as shankh prakshalana, interrupting the exercises at regular intervals to consume 480 mL of lukewarm saline. The solution was prepared by adding 9 g of sodium chloride per liter of lukewarm water (99°F-102°F/37.2°C-38.9°C). RESULTS: The mean total score was significantly better in Group A versus Group B (20.63 ± 5.09 versus 16.48 ± 5.18, p < 0.0007). In Group A, 24/27 (88.9%) of patients had excellent or optimum total scores, compared with 21/27 (77.8%) in Group B (not significant). In our pilot study, LWS/yoga, used under supervision, produced better colon preparation than Nulytely, used as directed. LIMITATIONS: A randomized, endoscopist-blinded study is needed to confirm these results. CONCLUSIONS: Shankh prakshalana is effective as a colonoscopy preparation.