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Bagshaw P, Cameron C, Aramowicz J, Frampton C, Pretty C. Randomized controlled trial of effects of a familiarization video and patient-controlled Entonox inhalation on patient stress levels and clinical efficacy of flexible sigmoidoscopy without analgesia or sedation for investigation of fresh rectal bleeding. J Gastroenterol Hepatol 2024; 39:464-472. [PMID: 38054398 DOI: 10.1111/jgh.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIM Flexible sigmoidoscopy (FS) without analgesia or sedation can be unpleasant for patients, resulting in unsatisfactory examinations. Prior familiarization videos (FVs) and intra-procedural Entonox inhalation have shown inconsistent effects. This study investigated their effects on undesirable participant factors (anxiety, stress, discomfort, pain, satisfaction, later unpleasant recall of procedure, and vasovagal reactions) and clinical effectiveness (extent of bowel seen, lesions detected, and procedural/recovery times). METHODS This cluster-randomized single-center study evaluated 138 participants undergoing FS. There were 46 controls, 49 given access to FV, and 43 access to both FV and self-administered Entonox. Participant factors were measured by self-administered questionnaires, independent nurse assessments, and heart rate variability (HRV) metrics. RESULTS Questionnaires showed that the FV group was slightly more tense and upset before FS, but knowledge of Entonox availability reduced anxiety. Nonlinear HRV metrics confirmed reduced intra-procedural stress response in the FV/Entonox group compared with controls and FV alone (P < 0.05). Entonox availability allowed more bowel to be examined (P < 0.001) but increased procedure time (P < 0.05), while FV alone had no effect. FV/Entonox participants reported 1 month after FS less discomfort during the procedure. Other comparisons showed no significant differences between treatment groups, although one HRV metric showed some potential to predict vasovagal reactions. CONCLUSIONS Entonox availability significantly improved clinical effectiveness and caused a slight reduction in undesirable participant factors. The FV alone did not reduce undesirable participant factors or improve clinical effectiveness. Nonlinear HRV metrics recorded effects in agreement with stress reduction and may be useful for prediction of vasovagal events in future studies.
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Affiliation(s)
- Philip Bagshaw
- Canterbury Charity Hospital Trust, Christchurch, New Zealand
| | | | - Jaana Aramowicz
- Canterbury Charity Hospital Trust, Christchurch, New Zealand
| | | | - Christopher Pretty
- Pūhanga | Engineering, University of Canterbury, Christchurch, New Zealand
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Cerdán Santacruz C, Muriel Álvarez P, Roig Ferreruela G, Merichal Resina M, Pinillos Somalo AI, Mestres Petit N, Sierra Grañón JE, Olsina Kissler JJ. Interval colonoscopy following acute diverticulitis should not be discouraged yet: results from a retrospective cohort. Surg Endosc 2021; 35:6819-6826. [PMID: 33398588 DOI: 10.1007/s00464-020-08187-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although included in some guidelines, the recommendation of interval colonoscopy after an acute diverticulitis (AD) episode has recently been questioned. In this study, we evaluated the incidence of colon cancer during the follow-up of an episode of AD. METHODS A retrospective review was carried out of patients with conservatively treated AD at our Institution (January 2011 to December 2018) with or without endoscopic study. Patients who had no colonoscopy performed were followed for two years. The demographic, clinical, radiological, follow-up and anatomopathological records were analysed. We determined CT scan validity for the differential diagnosis of CC and AD; sensibility, specificity, predictive values and likelihood ratios were calculated. Patients lost to follow-up and patients who had had colonoscopy in the previous three years were excluded. RESULTS This study included 285 patients with a mean age of 59 years. A total of 225 interval colonoscopies were performed and 60 patients without colonoscopy were followed up. There were 19 CC (6.7%) diagnosed, 14 with interval colonoscopy and 5 during follow-up; 8 (42.1%) happened in patients who had had an episode of uncomplicated AD. Although CT scan accuracy is high, 87.7%, positive and negative likelihood ratios were low, 4.67 and 0.64, respectively. CONCLUSIONS Interval colonoscopy should still be advisable after an episode of AD. The rationale for this statement is based on a non-negligible rate of hidden CC and an important uncertainty in the differential diagnosis.
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Affiliation(s)
- Carlos Cerdán Santacruz
- Colorectal Surgery Unit, General Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain.,Universidad de Lleida, Lleida, Spain
| | - Pablo Muriel Álvarez
- Liver, Biliary Tract and Pancreatic Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain. .,Institut de Recerca Biomédica de Lleida, Experimental Surgery Department, Av. Prat de la Riba 44, 4º 5ª, Lleida, Spain.
| | | | | | | | - Nuria Mestres Petit
- Colorectal Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain.,Universidad de Lleida, Lleida, Spain.,Institut de Recerca Biomédica de Lleida, Experimental Surgery Department, Av. Prat de la Riba 44, 4º 5ª, Lleida, Spain
| | - José Enrique Sierra Grañón
- Colorectal Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Jorge Juan Olsina Kissler
- Liver, Biliary Tract and Pancreatic Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain.,Universidad de Lleida, Lleida, Spain.,Institut de Recerca Biomédica de Lleida, Experimental Surgery Department, Av. Prat de la Riba 44, 4º 5ª, Lleida, Spain
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