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1.
Dig Endosc ; 34(6): 1176-1184, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35189669

RESUMO

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.


Assuntos
Adenoma , Pólipos do Colo , Adenoma/diagnóstico , Catárticos , Pólipos do Colo/diagnóstico , Pólipos do Colo/patologia , Colonoscopia , Humanos , Prevalência , Estudos Prospectivos
2.
Rev. esp. enferm. dig ; 112(9): 694-700, sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-200065

RESUMO

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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Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Próteses e Implantes , Intervalo Livre de Doença , Neoplasias Colorretais/mortalidade , Estadiamento de Neoplasias , Estimativa de Kaplan-Meier , Estudos Retrospectivos , Metástase Neoplásica
3.
Rev Esp Enferm Dig ; 112(9): 694-700, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32755149

RESUMO

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.


Assuntos
Neoplasias do Colo , Neoplasias Colorretais , Neoplasias Retais , Neoplasias Colorretais/cirurgia , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Stents , Resultado do Tratamento
4.
Endoscopy ; 52(11): 1026-1035, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32557475

RESUMO

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.


Assuntos
Colonoscopia , Telefone , Catárticos , Humanos , Análise de Intenção de Tratamento , Polietilenoglicóis , Estudos Prospectivos , Método Simples-Cego
5.
World J Gastroenterol ; 24(45): 5179-5188, 2018 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-30568394

RESUMO

AIM: To assess the incremental benefit of narrow band imaging (NBI) and white light endoscopy (WLE), randomizing the initial technique for the detection of residual neoplasia at the polypectomy scar after an endoscopic piecemeal mucosal resection (EPMR). METHODS: We conducted an observational study in an academic center to assess the incremental benefit of NBI and WLE randomly applied 1:1 (NBI-WLE or WLE-NBI) in the follow-up of a post-EPMR scar by the same endoscopist. RESULTS: A total of 112 EPMR scars were included. The median baseline polyp size was 20 mm (interquartile range: 14-30). At first review, NBI and WLE showed good sensitivity (85.0% vs 78.9%), specificity (77.1% vs 84.2%) and overall accuracy (80.0% vs 82.5%). NBI after WLE (WLE-NBI group) improved accuracy, but this difference was not statistically significant [area under the curve (AUC): 86.8% vs 81.6%, P = 0.15]. WLE after NBI (NBI-WLE group) did not improve accuracy (AUC: 81.4% vs 81.1%, P = 0.9). Overall, recurrence was found in 39/112 (34.8%) lesions. CONCLUSION: Although no statistically significant differences were found between the two techniques at the first post-EPMR assessment, the use of NBI after WLE may improve residual neoplasia detection. Nevertheless, biopsy is still required in the first scar review.


Assuntos
Cicatriz/diagnóstico por imagem , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Ressecção Endoscópica de Mucosa/efeitos adversos , Imagem de Banda Estreita/métodos , Idoso , Cicatriz/etiologia , Colo/diagnóstico por imagem , Colo/patologia , Colo/cirurgia , Pólipos do Colo/patologia , Ressecção Endoscópica de Mucosa/métodos , Feminino , Seguimentos , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Mucosa Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Distribuição Aleatória , Método Simples-Cego
6.
Rev. esp. enferm. dig ; 110(9): 571-576, sept. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-177778

RESUMO

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


Assuntos
Humanos , Endoscopia do Sistema Digestório/métodos , Diverticulite/diagnóstico por imagem , Neoplasias do Colo/diagnóstico por imagem , Neoplasias Colorretais/diagnóstico por imagem , Estudos Retrospectivos , Reprodutibilidade dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Qualidade da Assistência à Saúde
7.
Rev Esp Enferm Dig ; 110(9): 571-576, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29900742

RESUMO

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.


Assuntos
Diverticulite/diagnóstico por imagem , Endoscopia Gastrointestinal/métodos , Doença Aguda , Adulto , Idoso , Neoplasias do Colo/diagnóstico por imagem , Colonoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
8.
Neurodegener Dis Manag ; 6(3): 187-202, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27075968

RESUMO

Patients with Parkinson's disease often have a good initial response to dopaminergic therapy but later usually develop motor fluctuations and dyskinesia. In these patients, continuous infusion of levodopa-carbidopa intestinal gel (LCIG) allows for maintaining adequate dopamine levels and for improving motor and nonmotor symptoms, as well as quality of life and autonomy. Adequate candidate selection and follow-up are crucial for treatment success. Management should be multidisciplinary, and patient and caregiver education is a priority. This expert consensus document has been developed by a team of neurologists, gastroenterologists and nurses who have a vast experience in LCIG therapy, with an intention to provide knowledge and tools to facilitate patient management throughout all phases of LCIG treatment process.


Assuntos
Antiparkinsonianos/administração & dosagem , Carbidopa/administração & dosagem , Intestinos/efeitos dos fármacos , Levodopa/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Resultado do Tratamento , Carbidopa/normas , Cuidadores/psicologia , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/normas , Bases de Dados Bibliográficas/estatística & dados numéricos , Esquema de Medicação , Combinação de Medicamentos , Feminino , Seguimentos , Géis/administração & dosagem , Géis/normas , Humanos , Intestinos/fisiologia , Levodopa/normas , Masculino
10.
Clin Gastroenterol Hepatol ; 12(10): 1708-16.e4, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24681078

RESUMO

BACKGROUND & AIMS: We compared the ability of biennial fecal immunochemical testing (FIT) and one-time sigmoidoscopy to detect colon side-specific advanced neoplasms in a population-based, multicenter, nationwide, randomized controlled trial. METHODS: We identified asymptomatic men and women, 50-69 years old, through community health registries and randomly assigned them to groups that received a single colonoscopy examination or biennial FIT. Sigmoidoscopy yield was simulated from results obtained from the colonoscopy group, according to the criteria proposed in the UK Flexible Sigmoidoscopy Trial for colonoscopy referral. Patients who underwent FIT and were found to have ≥75 ng hemoglobin/mL were referred for colonoscopy. Data were analyzed from 5059 subjects in the colonoscopy group and 10,507 in the FIT group. The main outcome was rate of detection of any advanced neoplasm proximal to the splenic flexure. RESULTS: Advanced neoplasms were detected in 317 subjects (6.3%) in the sigmoidoscopy simulation group compared with 288 (2.7%) in the FIT group (odds ratio for sigmoidoscopy, 2.29; 95% confidence interval, 1.93-2.70; P = .0001). Sigmoidoscopy also detected advanced distal neoplasia in a higher percentage of patients than FIT (odds ratio, 2.61; 95% confidence interval, 2.20-3.10; P = .0001). The methods did not differ significantly in identifying patients with advanced proximal neoplasms (odds ratio, 1.17; 95% confidence interval, 0.78-1.76; P = .44). This was probably due to the lower performance of both strategies in detecting patients with proximal lesions (sigmoidoscopy detected these in 19.1% of patients and FIT in 14.9% of patients) vs distal ones (sigmoidoscopy detected these in 86.8% of patients and FIT in 33.5% of patients). Sigmoidoscopy, but not FIT, detected proximal lesions in lower percentages of women (especially those 50-59 years old) than men. CONCLUSIONS: Sigmoidoscopy and FIT have similar limitations in detecting advanced proximal neoplasms, which depend on patients' characteristics; sigmoidoscopy underperforms for women 50-59 years old. Screening strategies should be designed on the basis of target population to increase effectiveness and cost-effectiveness. ClinicalTrials.gov number: NCT00906997.


Assuntos
Colo/patologia , Neoplasias do Colo/diagnóstico , Fezes/química , Imuno-Histoquímica/métodos , Sigmoidoscopia/métodos , Idoso , Análise Custo-Benefício , Feminino , Humanos , Imuno-Histoquímica/economia , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Sigmoidoscopia/economia , Reino Unido
11.
J Natl Cancer Inst ; 105(12): 878-86, 2013 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-23708054

RESUMO

BACKGROUND: Screening for colorectal cancer with sigmoidoscopy benefits from the fact that distal findings predict the risk of advanced proximal neoplasms (APNs). This study was aimed at comparing the existing strategies of postsigmoidoscopy referral to colonoscopy in terms of accuracy and resources needed. METHODS: Asymptomatic individuals aged 50-69 years were eligible for a randomized controlled trial designed to compare colonoscopy and fecal immunochemical test. Sigmoidoscopy yield was estimated from results obtained in the colonoscopy arm according to three sets of criteria of colonoscopy referral (from those proposed in the UK Flexible Sigmoidoscopy, Screening for COlon REctum [SCORE], and Norwegian Colorectal Cancer Prevention [NORCCAP] trials). Advanced neoplasm detection rate, sensitivity, specificity, and number of individuals needed to refer for colonoscopy to detect one APN were calculated. Logistic regression analysis was performed to identify distal findings associated with APN. All statistical tests were two-sided. RESULTS: APN was found in 255 of 5059 (5.0%) individuals. Fulfillment of UK (6.2%), SCORE (12.0%), and NORCCAP (17.9%) criteria varied statistically significantly (P < .001). The NORCCAP strategy obtained the highest sensitivity for APN detection (36.9%), and the UK approach reached the highest specificity (94.6%). The number of individuals needed to refer for colonoscopy to detect one APN was 6 (95% confidence interval [CI] = 4 to 7), 8 (95% CI = 6 to 9), and 10 (95% CI = 8 to 12) when the UK, SCORE, and NORCCAP criteria were used, respectively. The logistic regression analysis identified distal adenoma ≥10 mm (odds ratio = 3.77; 95% CI = 2.52 to 5.65) as the strongest independent predictor of APN. CONCLUSIONS: Whereas the NORCCAP criteria achieved the highest sensitivity for APN detection, the UK recommendations benefited from the lowest number of individuals needed to refer for colonoscopy.


Assuntos
Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Sangue Oculto , Encaminhamento e Consulta , Sigmoidoscopia , Distribuição por Idade , Idoso , Neoplasias Colorretais/patologia , Feminino , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Distribuição por Sexo , Espanha/epidemiologia
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