Low Incidence of Advanced Neoplasia in Serrated Polyposis Syndrome After (Sub)total Colectomy: Results of a 5-Year International Prospective Cohort Study.

INTRODUCTION: Serrated polyposis syndrome (SPS) is accompanied by a substantially increased colorectal cancer (CRC) risk. To prevent or treat CRC in patients with a very high polyp burden, (sub)total colectomy with ileorectal or ileosigmoidal anastomosis is regularly performed. The CRC risk after (sub)total colectomy might be decreased, but evidence is lacking. We aimed to assess the yield of endoscopic surveillance in patients with SPS who underwent (sub)total colectomy. METHODS: For this post hoc analysis, we used prospectively collected data from a large international prospective cohort study. We included patients diagnosed with SPS (World Health Organization type I and/or III) who underwent (sub)total colectomy. Primary endpoint was the cumulative 5-year incidence of CRC and advanced neoplasia (AN). RESULTS: Forty-eight patients (mean age 61 [±7.8]; 52% men) were included and followed up for a median of 4.7 years (interquartile range 4.7-5.1). None of the patients developed CRC during follow-up. Five patients developed AN, corresponding to a cumulative 5-year AN incidence of 13% (95% confidence interval 1.2-23). In 4 patients, AN was diagnosed at the first surveillance endoscopy after study inclusion, and in 1 patient, AN was detected during subsequent rounds of surveillance. The risk of AN was similar for patients with ileorectal and ileosigmoidal anastomosis (logrank P = 0.83). DISCUSSION: (Sub)total colectomy mitigates much of the excess risk of CRC in patients with SPS. Advanced neoplasms are mainly detected at the first endoscopy after (sub)total colectomy. Based on these results, after the first surveillance, intervals might be extended beyond the currently recommended 1-2 years.

[Tolerability, safety, and efficacy of sodium phosphate preparation for colonoscopy: the role of age]. / Tolerancia, seguridad y eficacia de la preparación para colonoscopia con fosfato de sodio: el papel de la edad.

OBJECTIVES: To compare subjective tolerance and secondary adverse events to bowel cleansing prior to colonoscopy with polyethylene glycol (PEG) and sodium phosphate (NaP) in adult patients and in those 65 or more years old. MATERIAL AND METHODS: Retrospective matched study, choosing 140 patients among all of those who underwent colonoscopy from March 2004 to May 2005. We investigated the presence of the next adverse events during bowel preparation: Fever, low digestive bleeding, abdominal pain, perianal pain, nausea, vomiting, thirst, somnolence, agitation, tremor and convulsions. We considered bad objective tolerance if the patient presented any one of these events. We also asked patients about subjective tolerance to preparation. RESULTS: Seventy patients prepared with PEG and seventy with NaP were included (69 women and 71 men, mean age 60.6 +/- 14.8 years). There was no relationship between subjective tolerance or the presence of adverse events and bowel cleansing with any of the products in general population or in elderly patients (p = 0.09 and p = 0.45 in the elderly). However, patients prepared with NaP showed more nausea than those who employed PEG (p < 0.009), overall women of 65 or more years old. There were no severe adverse events in patients prepared with NaP. Elderly showed better tolerance than younger patients, and women worst tolerance than men, irrespective of the lavage preparation employed. Patients prepared with PEG unfinished bowel cleansing more frequently than those with NaP. Cleanliness achieved with NaP was significantly better than that obtained with PEG. CONCLUSIONS: Bowel cleansing prior to colonoscopy with NaP is as well tolerated, safe and effective as with PEG, even in elderly healthy patients, although it causes more nausea. Cleanliness with NaP is better than that achieved with PEG.

Tolerancia, seguridad y eficacia de la preparación para colonoscopia con fosfato de sodio: el papel de la edad / No disponible

Objetivos: comparar la tolerancia subjetiva y los efectos adversossecundarios a la preparación para colonoscopia con dosproductos, polietilenglicol (PEG) y fosfato de sodio (NaP), en pacientesadultos y en aquellos de 65 años o más.Material y métodos: estudio retrospectivo apareado, tras escogeraleatoriamente a 140 pacientes de todos los que se sometierona colonoscopia entre marzo de 2004 y mayo de 2005. Se investigóla presencia de los siguientes efectos adversos durante lapreparación para la colonoscopia: fiebre, rectorragia, dolor abdominal,dolor perianal, náuseas, vómitos, sed, somnolencia, agitación,temblor y convulsiones. Se consideró mala tolerancia objetiva si elpaciente presentó uno cualquiera de estos efectos. Asimismo, se recogióla tolerancia subjetiva al proceso de limpieza.Resultados: se incluyeron 70 pacientes preparados con PEGy 70 pacientes con NaP (69 mujeres y 71 hombres, con edad mediade 60,6 ± 14,8 años). No se demostró relación entre la toleranciasubjetiva o la presencia de efectos adversos y la limpieza conuno de los dos productos, ni en la población general ni en los pacientesde 65 años o más (p = 0,09 y p = 0,45 en los ancianos,respectivamente). A pesar de ello, los pacientes preparados conNaP presentaron más náuseas que los tratados con PEG (p <0,009), sobre todo las mujeres de 65 años o más. No se observaronefectos adversos graves en los pacientes preparados con NaP.Los ancianos toleraron mejor cualquiera de las dos preparacionesmientras que las mujeres toleraron peor que los hombres la preparación,independientemente del producto empleado. La probabilidadde no completar la limpieza fue mayor en el grupo preparadocon PEG y la calidad de ésta fue mejor en los que emplearon NaP.Conclusiones: la preparación previa a colonoscopia con NaPes tan bien tolerada, segura y eficaz como la realizada con PEG,también en pacientes ancianos sanos, a pesar de producir másnáuseas. La limpieza obtenida con NaP es de mejor calidad

Objectives: to compare subjective tolerance and secondaryadverse events to bowel cleansing prior to colonoscopy with polyethyleneglycol (PEG) and sodium phosphate (NaP) in adult patientsand in those 65 or more years old.Material and methods: retrospective matched study, choosing140 patients among all of those who underwent colonoscopyfrom March 2004 to May 2005. We investigated the presence ofthe next adverse events during bowel preparation: Fever, low digestivebleeding, abdominal pain, perianal pain, nausea, vomiting,thirst, somnolence, agitation, tremor and convulsions. We consideredbad objective tolerance if the patient presented any one ofthese events. We also asked patients about subjective tolerance topreparation.Results: seventy patients prepared with PEG and seventywith NaP were included (69 women and 71 men, mean age 60,6± 14,8 years). There was no relationship between subjective toleranceor the presence of adverse events and bowel cleansing withany of the products in general population or in elderly patients (p= 0,09 and p = 0,45 in the elderly). However, patients preparedwith NaP showed more nausea than those who employed PEG (p< 0,009), overall women of 65 or more years old. There were nosevere adverse events in patients prepared with NaP. Elderlyshowed better tolerance than younger patients, and women worsttolerance than men, irrespective of the lavage preparation employed.Patients prepared with PEG unfinished bowel cleansingmore frequently than those with NaP. Cleanliness achieved withNaP was significantly better than that obtained with PEG.Conclusions: bowel cleansing prior to colonoscopy with NaPis as well tolerated, safe and effective as with PEG, even in elderlyhealthy patients, although it causes more nausea. Cleanliness with NaP is better than that achieved with PEG (AU)

A young woman with first-trimester metrorrhagia, fever and skin lesions.

Inflammatory bowel disease commonly affects women with child-bearing potential, and clinical activity extent is most relevant at the time of conception. Below, we report on the case of a 19-year-old woman who was admitted for first-trimester metrorrhagia and fever, with various extraintestinal manifestations, mainly including erythema nodosum and episcleritis during the course of disease. The differential diagnosis of these manifestations led to the diagnosis of Crohn's disease, which involved the whole colon.

Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures.

OBJECTIVES: Propofol is a short-acting, hypnotic agent that is increasingly being used for gastrointestinal endoscopic sedation. There are concerns about the use of propofol by non anesthesiologists due to its potential for respiratory and cardiovascular depression. This report describes our experience concerning effectiveness and safety of propofol administered in endoscopic procedures by the endoscopist and the assistant nurse. METHODS: In this prospective study, a total of 102 consecutive endoscopies (60 colonoscopies and 42 upper endoscopies) performed under sedation with propofol were included. In 27 (26.47%) endoscopies propofol was administered alone and in 75 endoscopies (73.53%) it was combined with benzodiazepines and/or opioids. Seventy-six (74.51%) endoscopies were performed in patients under 65 years of age and 26 (25.49%) in patients over 65 years of age. Ninety-one (89.22%) endoscopies were performed in patients with low surgical risk (ASA I-II) and 11 (10.78%) in patients with high surgical risk. The medication was administered by the endoscopist that performed the procedure and the assistant nurse. RESULTS: The mean dose of propofol used was 72.14 mg for gastroscopies and 71.33 for colonoscopies (p = 0.92). The mean dose of propofol when infused alone was 84.81 mg whereas in combination with benzodiazepines/opioids was 66.93 mg (p = 0.06). The doses of propofol required were lower for those colonoscopies in which midazolam and/or meperidine was combined and in patients over 65 years of age (p = 0.006 y p = 0.001, respectively). Eleven (10.8%) minor complications were reported, and managed by the own endoscopist. Patients had no memories of the procedure. The tolerance rated by the endoscopist was excellent-good, fair, bad-very bad in 83, 5 and 12% of the gastroscopies and in 79, 8 and 13% of the colonoscopies respectively. Nevertheless bad tolerance did not hinder the completion of the procedure in any case. CONCLUSIONS: The administration of propofol by the endoscopist and the assistant nurse, is an effective and safe method of sedation in patients of low and high-risk as well as in elderly patients. The doses of propofol required for an adequate sedation were lower in patients over 65 years of age and for colonoscopies in which medication was combined.

Mujer joven con metrorragia del primer trimestre, fiebre y lesiones cutáneas / Clinicopathological Conference A young woman with first-trimester metrorrhagia, fever and skin lesions

La enfermedad inflamatoria intestinal afecta frecuentemente a mujeres en edad fértil, siendo fundamental el grado de actividad clínica en el momento de la concepción. A continuación se presenta el caso de una mujer de 19 años que ingresa por metrorragia del primer trimestre y fiebre; destacando durante su evolución la aparición de diferentes manifestaciones extraintestinales, fundamentalmente eritema nodoso y epiescleritis. A través del diagnóstico diferencial de estas manifestaciones se llegó al diagnóstico de una enfermedad de Crohn que afectaba a todo el colon

Administración controlada de propofol por el endoscopista: un método efectivo y seguro de sedación en endoscopia / Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures

Objetivos: el propofol es un agente hipnótico de acción rápidautilizado de forma cada vez más frecuente en la endoscopia digestiva.Existen controversias sobre su utilización por no anestesistas,dado su potencial efecto cardiodepresor. Este estudiodescribe nuestra experiencia en cuanto a efectividad y seguridaddel propofol, administrado por el endoscopista y su enfermera, enla endoscopia digestiva.Métodos: en este estudio prospectivo, se incluyeron un totalde 102 endoscopias (60 colonoscopias y 42 gastroscopias) realizadasbajo sedación con propofol. En 27 (26,47%) endoscopiasse empleó sólo propofol y en 75 endoscopias (73,53%) se asociómidazolam y/o meperidina. Se realizaron 76 (74,51%) endoscopiasen menores de 65 años y 26 (25,49%) en pacientes mayoresde 65 años. Fueron realizadas 91 (89,22%) endoscopias en pacientescon bajo riesgo quirúrgico (ASA I-II) y 11 (10,78%) en pacientescon alto riesgo quirúrgico. La sedación fue administradapor el endoscopista que realizaba la exploración y su enfermeraasistente.Resultados: las dosis media de propofol fue de 72,14 mgen las gastroscopias y de 71,33 en las colonoscopias (p = 0,92).La dosis media de propofol cuando no se asoció comedicaciónfue de 84,81 mg y en presencia de comedicación de 66,93 (p =0,06). Las dosis de propofol requeridas fueron significativamentemenores en las colonoscopias en las que se asoció midazolamy/o meperidina y en pacientes mayores de 65 años (p =0,006 y p = 0,001, respectivamente). Se observaron 11(10,8%) incidencias de carácter leve y resueltas por el propio endoscopista.Ningún paciente guardaba recuerdo de la exploración.La tolerancia registrada por el endoscopista fue muy buena-buena, regular y mala-muy mala en 83, 5 y 12% de lasgastroscopias y en el 79, 8 y 13% de las colonoscopias respectivamente.Sin embargo la mala tolerancia no impidió completarla endoscopia en ningún caso.Conclusiones: el empleo de propofol, administrado por elendoscopista y su enfermera, es una técnica efectiva y segurade sedación en pacientes de bajo y alto riesgo anestésico asícomo en pacientes mayores de 65 años. Las dosis de propofolprecisas para una adecuada sedación son menores en pacientesmayores de 65 años y en las colonoscopias en las que se asocia

comedicaciónObjectives: propofol is a short-acting, hypnotic agent thatis increasingly being used for gastrointestinal endoscopic sedation.There are concerns about the use of propofol by nonanesthesiologists due to its potential for respiratory and cardiovasculardepression. This report describes our experience concerningeffectiveness and safety of propofol administered in endoscopicprocedures by the endoscopist and the assistantnurse.Methods: in this prospective study, a total of 102 consecutiveendoscopies (60 colonoscopies and 42 upper endoscopies) performedunder sedation with propofol were included. In 27(26.47%) endoscopies propofol was administered alone and in 75endoscopies (73.53%) it was combined with benzodiazepinesand/or opioids. Seventy-six (74.51%) endoscopies were performedin patients under 65 years of age and 26 (25.49%) in patientsover 65 years of age. Ninety-one (89.22%) endoscopieswere performed in patients with low surgical risk (ASA I-II) and 11(10.78%) in patients with high surgical risk. The medication wasadministered by the endoscopist that performed the procedureand the assistant nurse.Results: the mean dose of propofol used was 72.14 mg forgastroscopies and 71.33 for colonoscopies (p = 0.92). The meandose of propofol when infused alone was 84.81 mg whereas incombination with benzodiazepines/opioids was 66.93 mg (p =0.06). The doses of propofol required were lower for thosecolonoscopies in which midazolam and/or meperidine was combinedand in patients over 65 years of age (p = 0.006 y p =0.001, respectively). Eleven (10.8%) minor complications werereported, and managed by the own endoscopist. Patients had nomemories of the procedure. The tolerance rated by the endoscopistwas excellent-good, fair, bad-very bad in 83, 5 and 12% ofthe gastroscopies and in 79, 8 and 13% of the colonoscopies respectively.Nevertheless bad tolerance did not hinder the completionof the procedure in any case.Conclusions: the administration of propofol by the endoscopistand the assistant nurse, is an effective and safe method ofsedation in patients of low and high-risk as well as in elderly patients.The doses of propofol required for an adequate sedationwere lower in patients over 65 years of age and for colonoscopiesin which medication was combined