Bowel preparation for colonoscopy: comparison of mannitol and sodium phosphate. Results of a prospective randomized study.

METHOD: Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750ml of 10% mannitol (Group M) or 180ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS: Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85% prepared with sodium phosphate versus 82.5% for mannitol (p=0.37). CONCLUSIONS: Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure.

Pouchitis: extracolonic manifestation of ulcerative colitis?

Pouchitis is the most frequent complication of ileal pouch-anal anastomosis for treatment of ulcerative colitis. There are several possible explanations. Among them, we focus on the one that considers pouchitis as an extracolonic manifestation of ulcerative colitis. The aim of this study was to investigate the association between pouchitis and extra-intestinal manifestations (EIM), which are frequent in these patients. Sixty patients underwent restorative proctocolectomy with an ileal J pouch (IPAA) from September 1984 to December 1998. Pouchitis was defined by clinical, endoscopic, and histologic criteria. The following extra-intestinal manifestations were studied: articular, cutaneous, hepatobiliary, ocular, genitourinary, and growth failure. Thirteen patients, of which 10 were female (76.9%), developed one or more episodes of pouchitis. Twelve patients of this group (92.3%) presented some kind of extra-intestinal manifestation, 4 pre-operatively (exclusively), 2 post-operatively (exclusively), and 6 both pre- and post-operatively (1.7 per patient). Twenty patients (42.7%) of the 47 without pouchitis did not present extra-intestinal manifestations; 10/35 (28. 5%) of females had pouchitis, compared to 3/35 (12.0%) of men. Pouchitis was more frequent among females, though not statistically significant. EIM increases the risk of pouchitis. Pouchitis is related to EIM in 92.3 % of cases, corroborating the hypothesis that it could be an extracolonic manifestation of ulcerative colitis.

[Colonic Crohn's disease: results of treatment]. / Doença de Crohn exclusiva no intestino grosso: resultados do tratamento.

Sixty patients with Crohn's colitis were separated into 2 groups: A) without perianal lesions, 12 patients; B) with perianal lesions, 48 patients. The mean age at the beginning of symptomatology was 41.4 years in group A and 31.7 in B. The number of patients that underwent surgical treatment were similar in both groups. Fifty eight operations were performed in 29 patients, mean 0.33 operations/patient in group A and 2.16 in B. Ileal pouch anal anastomosis were performed in 5 patients, with loss of reservoir in one. There was no difference in need of hospitalization between the 2 groups. At mean follow-up of 8.9 years, 37 patients presented at least one extra-intestinal manifestation, 21 a perianal lesion, 39 were taking drugs and 31 were symptomatic. In the group of 31 patients that received only medical treatment, 24 (77.4%) are still on drugs and only 9 are assymptomatic. In the group of 29 patients that were operated on, 12 (41.4%) are taking drugs and 19 (65.5%) are assymptomatic. The difference concerning results of treatment between patients on medical treatment and operated were statistically significant. A permanent ileostomy was performed in 19(65.5%) patients. Two patients died during clinical treatment and one of postoperative complications.

Stapled anastomosis in colorectal surgery.

The authors review their experience with stapled anastomosis in colorectal and ileorectal resections for malignant and benign lesions of the large bowel. They describe the technique and results in a series of 49 patients (24 with cancer of the rectum and rectosigmoid junction; six with familial polyposis, associated with cancer in four; 12 with chagastic megacolon; three, Crohn's disease; two, ulcerative colitis; and one each, diverticular sigmoiditis and ischemic sigmoiditis). Anterior resection was performed in 38 patients and total colectomy with ileorectal anastomosis in 11. Main complications and mortality are presented. They conclude that stapled anastomosis is an efficient method for intestinal reconstruction after resection for malignant and benign lesions of the large bowel.