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Zhang YY, Vimala R, Chui PL, Hilmi IN. A Systematic Review of Exercise Therapy for Bowel Preparation: Evidence to Guide Practice. Gastroenterol Nurs 2023; 46:393-403. [PMID: 37347807 DOI: 10.1097/sga.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023] Open
Abstract
This systematic review aims to evaluate (1) the effectiveness of exercise therapy in bowel preparation for colonoscopy, and (2) the characteristics of exercise programs for bowel preparation. Systematic searches were done in PubMed, EMBASE, the Cochrane Library, Web of Science, and CINAHL from inception to November 2022. Randomized controlled trials and quasi-experimental studies assessing the efficacy of exercise during bowel preparation were included in this review. Two reviewers independently assessed the methodological quality using a modified Downs and Black checklist. A narrative synthesis was conducted. A total of five studies (1,109 participants) were included in this review. In all eligible studies, the characteristics of the exercise programs varied and included mainly two types of exercise (walking and yoga), various amount of exercise (3,000-10,000 steps or 0.5-1.9 hours), and two exercise timing (during and 1 hour after taking the laxative). Available evidence indicated that exercise therapy is effective in improving the quality of bowel preparation. However, there was insufficient high-quality evidence to conclude the effects on procedure-related indicators, adverse events, and willingness to repeat preparation. Exercise should be recommended as an important part of routine bowel preparation for patients undergoing colonoscopy to improve the quality of bowel preparation. More rigorous studies focusing on the effects on procedure-related indicators, adverse events, and willingness to repeat preparation are needed. To ensure the effectiveness and safety of the intervention, it is critical to establish a standard, well-structured exercise program for bowel preparation.
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Affiliation(s)
- Yuan-Yuan Zhang
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ramoo Vimala
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ping Lei Chui
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ida Normiha Hilmi
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Lu Q, Xiong F, Wang XY, Zeng T, Lin DY, Liu WH. Intestinal topical lidocaine spray improves the efficacy and safety of endoscopic sigmoid polypectomy. Eur J Gastroenterol Hepatol 2023; 35:822-828. [PMID: 37395233 DOI: 10.1097/meg.0000000000002577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND AND AIMS Endoscopic polypectomy can prevent colorectal cancer. Adequate surgical field visualization is crucial to complete resection. To prevent visual field loss caused by intestinal peristalsis, we investigated the efficacy and safety of topical lidocaine spraying during the endoscopic sigmoid polypectomy (ESP). METHODS Retrospective analysis was performed on 100 ESP patients admitted from July 2021 to October 2021, among which 50 patients received lidocaine (case group) and other 50 patients received normal saline (control group). Lidocaine or saline was sprayed on the colonic mucosa within 5 cm above and below the polyps before polypectomy. The en-bloc resection rate (EBRR) and complete resection rate (CRR) were primarily evaluated. Secondary outcomes included EBRR for polyps located in the 5-11 o'clock position, sigmoid colon peristalsis frequency, degree of exposure to the surgical field, operative times, and adverse events. RESULTS There were no significant differences in the basic demographic characteristics between the two groups. EBRR and CRR in the case group were 72.9% and 95.8%, and in the control group were 53.3% and 91.1%, respectively. The EBRR of sigmoid polyps located at the 5-11 o'clock positions was significantly higher in the case group (82.8%) than in the control group (56.7%) (P = 0.03). Sigmoid colonic peristalsis was significantly inhibited after lidocaine spraying (P < 0.01). There was no statistical difference in the operative times and adverse event rates between the two groups. CONCLUSION Topical spraying lidocaine around polyps can safely and effectively reduce intestinal peristalsis, thus improving the EBRR of sigmoid polypectomy.
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Affiliation(s)
- Qin Lu
- Department of Gastroenterology and Hepatology
| | - Fei Xiong
- Department of Gastroenterology and Hepatology
| | - Xiang-Yin Wang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Ting Zeng
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Da-Yong Lin
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Wei-Hui Liu
- Department of Gastroenterology and Hepatology
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Wu J, Zhao SB, Wang SL, Fang J, Xia T, Su XJ, Xu C, Li ZS, Bai Y. Comparison of efficacy of colonoscopy between the morning and afternoon: A systematic review and meta-analysis. Dig Liver Dis 2018; 50:661-667. [PMID: 29776746 DOI: 10.1016/j.dld.2018.03.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Colonoscopy performed in the afternoon, rather than morning, has been reported to be associated with lower rates of adenoma and polyp detection (ADR and PDR) and cecal intubation (CIR). This meta-analysis evaluated the efficacy of afternoon colonoscopy relative to morning colonoscopy. METHODS The databases MEDLINE, Web of Science, EMBASE, and the Cochrane Library were searched to identify potential relevant studies. The primary outcome was ADR and the secondary outcomes were CIR and PDR. The outcomes were estimated by relative risk (RR) and 95% confidence interval (CI) with a random effects model. RESULTS Sixteen studies with 38,063 participants met the inclusion criteria. The pooled analyses indicated that ADR (RR: 1.08, 95% CI: 1.00-1.17) and CIR (RR: 1.01, 95% CI: 1.00-1.02) were stable during the whole day. In subgroup analyses, the effect of full-day block or inferior bowel preparation were more prominent, reflected by a significant reduction of ADR (RR: 1.18, 95% CI: 1.09-1.28; RR: 1.12, 95% CI: 1.01-1.24) and CIR (RR: 1.08, 95% CI: 1.02-1.13; RR: 1.02, 95% CI: 1.01-1.03) in the afternoon, respectively. CONCLUSIONS Colonoscopy quality, as indicated by the ADR and CIR, is not affected by the time of day for procedures performed in block shifts. However, endoscopists' working full-day blocks and inferior bowel preparation are associated with a significant decrease in ADR and CIR in the afternoon.
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Affiliation(s)
- Junqi Wu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Student Brigade, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Sheng-Bing Zhao
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Shu-Ling Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Jun Fang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Tian Xia
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Xiao-Ju Su
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Can Xu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.
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Ching HL, Hale MF, Sidhu R, McAlindon ME. Reassessing the value of gastroscopy for the investigation of dyspepsia. Frontline Gastroenterol 2018; 9:62-66. [PMID: 29484162 PMCID: PMC5824766 DOI: 10.1136/flgastro-2017-100838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/29/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic yield of investigating dyspepsia with oesophagogastroduodenoscopy (OGD) with or without mucosal biopsy. DESIGN Retrospective service evaluation study. SETTING Two teaching hospitals: The Royal Hallamshire Hospital and Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK. PATIENTS 500 patients, 55 years of age and over, who underwent OGD to investigate dyspepsia were included. The study period included a 3-month window. All OGDs were performed on an outpatient basis. INTERVENTIONS Data were extracted from electronic OGD records within the study period. MAIN OUTCOME MEASURES Diagnostic yield provided by endoscopic examination and histological assessment. RESULTS 378 patients (75.6%) were reported to have some form of endoscopic abnormality, and 417 patients (83.4%) had biopsies taken. The most common findings at OGD were gastritis (47.2%) and oesophagitis (24.4%). Oesophagogastric malignancy was seen in 1%. Diagnoses made endoscopically or histologically that would not have been appropriately managed by empirical therapies were seen in 16.2%. CONCLUSION OGD in dyspepsia influences patient management in approximately one-sixth of cases. However, the majority of patients are sufficiently managed with Helicobacter pylori testing and eradication and/or a trial of proton pump inhibitor therapy. Further non-invasive approaches are needed to identify patients who need endoscopy for biopsy or therapy.
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Affiliation(s)
- Hey-Long Ching
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Melissa F Hale
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Reena Sidhu
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Mark E McAlindon
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
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Klare P, Phlipsen H, Haller B, Einwächter H, Weber A, Abdelhafez M, Bajbouj M, Brown H, Schmid RM, von Delius S. Longer observation time increases adenoma detection in the proximal colon - a prospective study. Endosc Int Open 2017; 5:E1289-E1298. [PMID: 29218322 PMCID: PMC5718907 DOI: 10.1055/s-0043-121072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/08/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Longer observation times are associated with increased adenoma detection rates (ADR) in the entire colon. However, adenomas in the proximal colon are at risk of being missed during colonoscopy. The aim of this study was to investigate the impact of observation time on detection of adenomatous polyps in the proximal colon. PATIENTS AND METHODS This was a prospective study at a university hospital in Germany. Colonoscopies were conducted using magnetic endoscope imaging (MEI) in order to determine the exact position of the scope. Exact observation times spent for the detection of polyps in the proximal and distal colon segments were assessed. The primary outcome was adenoma detection in the proximal colon. ROC curves were generated in order to test the correlation between observation time and adenoma detection. Logistic regression analysis was used to check for interfering factors. RESULTS A total 480 procedures with 538 polyps were available for analysis. The overall adenoma detection rate was 38.5 %. ADR in the proximal colon was 28.0 %. There was a significant association between observation time in the proximal colon and the detection of proximal adenomas ( P < 0.001). The impact of the time factor on ADR was stronger in the proximal compared to the distal colon ( P = 0.030). A net period of 4 min 7 sec was found to be the minimum time span for sufficient adenoma detection in the proximal colon. CONCLUSION Observation time is significant in terms of adenoma detection in the proximal colon. The impact of observation time on ADR is stronger in the proximal compared to the distal colon. In the proximal colon a minimum time span of 4 minutes should be spent in order to ensure adequate adenoma detection.
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Affiliation(s)
- Peter Klare
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany,Corresponding author Peter Klare, MD II. Medizinische KlinikKlinikum rechts der IsarIsmaninger Str. 22, 81675 MünchenGermany+49 894140 4905
| | - Henrik Phlipsen
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Henrik Einwächter
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Andreas Weber
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Mohamed Abdelhafez
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Monther Bajbouj
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Hayley Brown
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Roland M. Schmid
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Stefan von Delius
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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