Bowel cleansing effectiveness and safety of 1L PEG + Asc in the real-world setting: Observational, retrospective, multicenter study of over 13000 patients.

Background and study aims Effective bowel cleansing is critical for detecting lesions during colonoscopy, highlighting the importance of bowel preparations. 1L polyethylene glycol (PEG) + ascorbate (Asc) is the only recommended 1L PEG product in Europe and the United States. Its efficacy was demonstrated in large-scale controlled trials and confirmed in smaller-scale real-world studies. However, no large-scale real-world data exist. Patients and methods This observational, retrospective, multicenter study, used outpatient follow-up data from medical records from 10 centers in Spain and two in Portugal. Outpatients aged ≥18 years using 1L PEG + Asc as bowel preparation were included. The main outcome measures were overall adequate colon cleansing (Boston Bowel Preparation Scale [BBPS] score ≥6 with BBPS score ≥2 in each segment) and high-quality cleansing of the right colon (BBPS score=3). Results Data from 13169 eligible patients were included. Overall cleansing success was achieved in 89.3% (95%CI 88.7%-89.8%) and high-quality cleansing in the right colon in 49.3% (95%CI 48.4%-50.2%) of patients. For the overnight split-dose and same-day regimens, overall adequate quality cleansing success rate was 94.7% and 86.7% ( P <0.0001) and high-quality cleansing of the right colon rate was 65.4% and 41.4% ( P <0.0001), respectively. Colonoscopy was completed in 97.3% of patients, with non-completion due to poor preparation in only 0.8%; 2.3% of patients experienced at least one adverse event (AE). Conclusions This large-scale, real-world study demonstrates the effectiveness of 1L PEG + Asc in the total and right colon, with a low percentage of patients with AEs in routine clinical practice.

Prevalence of missed lesions in patients with inadequate bowel preparation through a very early repeat colonoscopy.

OBJECTIVES: When bowel preparation (BP) is inadequate, international guidelines recommend repeating the colonoscopy within 1 year to avoid missing clinically relevant lesions. We aimed to determine the rate of missed lesions in patients with inadequate BP through a very early repeat colonoscopy with adequate BP. METHODS: Post hoc analysis was conducted using data collected from a prospective multicenter randomized clinical trial including patients with inadequate BP and then repeat colonoscopy. Inadequate BP was defined as the Boston Bowel Preparation Scale (BBPS) score <2 points in any segment. We included patients with any indication for colonoscopy. The adenoma detection rate (ADR), advanced ADR (AADR), and serrated polyp detection rate (SPDR) were calculated for index and repeat colonoscopies. RESULTS: Of the 651 patients with inadequate BP from the original trial, 413 (63.4%) achieved adequate BP on repeat colonoscopy. The median interval between index and repeat colonoscopies was 28 days. On repeat colonoscopy, the ADR was 45.3% (95% confidence interval [CI] 40.5-50.1%), the AADR was 10.9% (95% CI 8.1-14.3%), and the SPDR was 14.3% (95% CI 10.9-17.7%). Cancer was discovered in four patients (1%; 95% CI 0.2-2.5%). A total of 60.2% of all advanced adenoma (AA) were discovered on repeat colonoscopy. A colon segment scored BBPS = 0 had most AA (66.1%) and all four cancers. CONCLUSION: Patients with inadequate BP present a high rate of AAs on repeat colonoscopy. When a colonoscopy has a colon segment score BBPS = 0, we recommend repeating the colonoscopy as soon as possible.

Prótesis de colon vs. resección quirúrgica del tumor primario. Efecto en la supervivencia del cáncer de colon obstructivo estadio IV / No disponible

INTRODUCCIÓN Y OBJETIVOS: el impacto de la resección quirúrgica del tumor primario en la supervivencia del cáncer colorrectal metastático obstructivo es aún controvertido. El objetivo principal de este estudio ha sido analizar la supervivencia de pacientes con cáncer colorrectal metastático obstructivo tras tratamiento con cirugía resectiva o con prótesis de colon. MATERIAL Y MÉTODOS: estudio retrospectivo de todos los pacientes con cáncer colorrectal estadio IV con clínica obstructiva diagnosticados entre 2005 y 2012 y tratados con cirugía resectiva o prótesis de colon. Se han excluido casos con perforación, absceso, neoplasia en colon derecho o recto distal, neoplasia colorrectal múltiple y cirugía derivativa. RESULTADOS: se incluyeron 95 pacientes, 49 tratados con cirugía resectiva y 46 con prótesis de colon. El grupo tratado con prótesis presentó mayor índice de Charlson (9,5 ± 2,1 vs. 8,6 ± 1,5, p = 0,01), menor tiempo para la ingesta oral (0,9 ± 1,1 vs. 16,4 ± 53,5 días, p = 0,05), menor estancia hospitalaria (4 ± 4,8 vs. 16,7 ± 15,5 días, p = 0,0001), menor necesidad de estoma (11,1 % vs. 32,7 %, p = 0,01), menos complicaciones precoces (4,3 % vs. 46,9 %, p = 0,0001) y más complicaciones tardías (33,3 % vs. 6,4 %, p = 0,001). Recibir quimioterapia (p = 0,008) fue el único factor independiente de mayor supervivencia. En el subgrupo de pacientes tratados con quimioterapia la resección quirúrgica del tumor primario fue un factor independiente de mayor supervivencia. CONCLUSIÓN: en los pacientes diagnosticados de cáncer colorrectal obstructivo estadio IV, ambos tratamientos son eficaces en la resolución del cuadro obstructivo. La cirugía resectiva no impacta de forma positiva en la supervivencia y no puede ser recomendada como terapia de elección

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Colonic stent vs surgical resection of the primary tumor. Effect on survival from stage-IV obstructive colorectal cancer.

BACKGROUND AND OBJECTIVES: the impact of surgical primary tumor resection on survival of obstructive metastatic colorectal cancer remains controversial. The primary goal of this study was to analyze survival in patients with obstructive metastatic colorectal cancer after treatment with either resection surgery or a colonic stent. MATERIAL AND METHODS: a prospective study was performed of all patients with stage-IV colorectal cancer and obstructive manifestations, diagnosed from 2005 to 2012 and managed with either resection surgery or a colonic stent. Cases with a perforation, abscess, right colon or distal rectal malignancy, multiple colorectal cancer or derivative surgery were excluded. RESULTS: a total of 95 patients were included, 49 were managed with resection surgery and 46 with a colonic stent. The colonic stent group had a higher Charlson index (9.5 ± 2.1 vs 8.6 ± 1.5, p = 0.01), a shorter time to oral intake (0.9 ± 1.1 vs 16.4 ± 53.5 days, p = 0.05), a shorter hospital stay (4 ± 4.8 vs 16.7 ± 15.5 days, p = 0.0001), less need for stomata (11.1 % vs 32.7 %, p = 0.01), fewer early complications (4.3 % vs 46.9 %, p = 0.0001) and more late complications (33.3 % vs 6.4 %, p = 0.001). Undergoing chemotherapy (p = 0.008) was the only independent factor related to increased survival. In the subgroup of patients managed with chemotherapy, surgical primary tumor resection was an independent factor associated with increased survival. CONCLUSION: both treatments are effective for resolving obstructive manifestations in patients diagnosed with stage-IV obstructive colorectal cancer. Resection surgery has no positive impact on survival and thus cannot be recommended as a therapy of choice.

Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure: a multicenter randomized trial.

BACKGROUND: The most important predictor of unsuccessful bowel preparation is previous failure. For those patients with previous failure, we hypothesized that a nurse-led educational intervention by telephone shortly before the colonoscopy appointment could improve cleansing efficacy. METHODS: We performed a multicenter, endoscopist-blinded, randomized controlled trial. Consecutive outpatients with previous inadequate bowel preparation were enrolled. Both groups received the same standard bowel preparation protocol. The intervention group also received reinforced education by telephone within 48 hours before the colonoscopy. The primary outcome was effective bowel preparation according to the Boston Bowel Preparation Scale. Intention-to-treat (ITT) analysis included all randomized patients. Per-protocol analysis included patients who could be contacted by telephone and the control cases. RESULTS: 657 participants were recruited by 11 Spanish hospitals. In the ITT analysis, there was no significant difference between the intervention and control groups in the rate of successful bowel preparation (77.3 % vs. 72 %; P = 0.12). In the intervention group, 267 patients (82.9 %) were contacted by telephone. Per-protocol analysis revealed significantly improved bowel preparation in the intervention group (83.5 % vs. 72.0 %; P = 0.001). CONCLUSION: Among all patients with previous inadequate bowel preparation, nurse-led telephone education did not result in a significant improvement in bowel cleansing. However, in the 83 % of patients who could be contacted, bowel preparation was substantially improved. Phone education may therefore be a useful tool for improving the quality of bowel preparation in those cases.

Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated? / Endoscopia digestiva baja de rutina en la diverticulitis aguda confirmada radiológicamente. ¿En quién y cuándo está indicada?

Introduction: international guidelines recommend a routine colonoscopy to rule out advanced neoplasm after an acute diverticulitis event. However, in recent years, this recommendation has been called into question following the advent of computerized tomography (CT), particularly with regard to uncomplicated diverticulitis. Furthermore, colonoscopy is associated with a risk and additional costs. Objective: to understand the diagnostic yield, quality and safety of colonoscopy in the setting of acute diverticulitis. Methods: this was a retrospective study of all patients diagnosed with acute diverticulitis via CT between 2005 and 2013, who subsequently underwent a colonoscopy. Results: two hundred and sixteen patients diagnosed with acute diverticulitis via CT were enrolled. These included 58 cases with complicated diverticulitis (27%) and 158 with uncomplicated diverticulitis (73%). An advanced neoplasm was found in 12 patients (5.6%); 11.7% were complicated and 3.2% were uncomplicated (p = 0.02). No major complications were identified. The quality was low but improved over time; the complete procedure rate was 88%, an effective preparation was achieved in 75% and excision of polyps < 2 cm was performed in 78% of cases. The optimum colonoscopy quality cu-off was 9.5 weeks. Conclusion: routine colonoscopy is advisable after a complicated diverticulitis event but its recommendation is unclear with regard to uncomplicated episodes. Colonoscopy is safe even when performed early. The overall quality is low but may be optimized via a subsequent endoscopy, two months after a diverticulitis diagnosis

Introducción: las guías internacionales recomiendan la colonoscopia de rutina tras un episodio de diverticulitis aguda para descartar la presencia de neoplasia avanzada. Sin embargo, tras la incorporación en los últimos años de la tomografía axial computarizada dicha recomendación ha quedado en entredicho, sobre todo en lo que se refiere a la diverticulitis no complicada. Por otro lado, la colonoscopia es una técnica que comporta riesgos y costes adicionales. Objetivo: conocer la rentabilidad diagnóstica, calidad y seguridad de la colonoscopia en la diverticulitis aguda. Métodos: estudio retrospectivo de todos los pacientes diagnosticados de diverticulitis aguda por tomografía computarizada (TC) entre los años 2005 y 2013, a los que posteriormente se les realizó una colonoscopia. Resultados: doscientos dieciséis pacientes diagnosticados de diverticulitis aguda por TC (58 diverticulitis complicada [27%] y 158 diverticulitis no complicada [73%]) fueron incluidos. Se detectó neoplasia avanzada en 12 pacientes (5,6% [complicada/no complicada 11,7/3,2%, p = 0,02]). No se observaron complicaciones mayores. La calidad fue baja (completa: 88%; preparación eficaz: 75%; resección de pólipos < 2 cm: 78%), si bien mejoró con el paso del tiempo, siendo las 9,5 semanas el punto de corte óptimo de calidad para realizar la colonoscopia. Conclusión: es aconsejable la realización de una colonoscopia de rutina tras un episodio de diverticulitis complicada, pero la recomendación no es clara en la no complicada. La colonoscopia es segura incluso realizada de forma precoz. La calidad es globalmente baja pero podría optimizarse realizando la endoscopia posteriormente a los dos meses del diagnóstico de la diverticulitis

Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated?

INTRODUCTION: international guidelines recommend a routine colonoscopy to rule out advanced neoplasm after an acute diverticulitis event. However, in recent years, this recommendation has been called into question following the advent of computerized tomography (CT), particularly with regard to uncomplicated diverticulitis. Furthermore, colonoscopy is associated with a risk and additional costs. OBJECTIVE: to understand the diagnostic yield, quality and safety of colonoscopy in the setting of acute diverticulitis. METHODS: this was a retrospective study of all patients diagnosed with acute diverticulitis via CT between 2005 and 2013, who subsequently underwent a colonoscopy. RESULTS: two hundred and sixteen patients diagnosed with acute diverticulitis via CT were enrolled. These included 58 cases with complicated diverticulitis (27%) and 158 with uncomplicated diverticulitis (73%). An advanced neoplasm was found in 12 patients (5.6%); 11.7% were complicated and 3.2% were uncomplicated (p = 0.02). No major complications were identified. The quality was low but improved over time; the complete procedure rate was 88%, an effective preparation was achieved in 75% and excision of polyps < 2 cm was performed in 78% of cases. The optimum colonoscopy quality cu-off was 9.5 weeks. CONCLUSION: routine colonoscopy is advisable after a complicated diverticulitis event but its recommendation is unclear with regard to uncomplicated episodes. Colonoscopy is safe even when performed early. The overall quality is low but may be optimized via a subsequent endoscopy, two months after a diverticulitis diagnosis.

Hematemesis secundaria a cuerpo extraño gástrico en un body packer / Gastric foreign body-induced hematemesis in a body packer

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