1
|
Beydoun HA, Tsai J. Lifetime prevalence and correlates of colorectal cancer screening among low-income U.S. Veterans. Cancer Causes Control 2024:10.1007/s10552-024-01881-5. [PMID: 38714606 DOI: 10.1007/s10552-024-01881-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/10/2024] [Indexed: 05/10/2024]
Abstract
PURPOSE The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S. While preventive healthcare services are high priority in the VHA, low-income U.S. Veterans experience adverse life circumstances that may negatively impact their access to these services. This study examined lifetime prevalence as well as demographic, socioeconomic, military-specific, and clinical correlates of colorectal cancer (CRC) screening among low-income U.S. Veterans ≥ 50 years of age. METHODS Cross-sectional data on 862 participants were analyzed from the 2021-2022 National Veteran Homeless and Other Poverty Experiences study. RESULTS Overall, 55.3% (95% confidence interval [CI] 51.3-59.3%) reported ever-receiving CRC-screening services. In a multivariable logistic regression model, never-receivers of CRC screening were twice as likely to reside outside of the Northeast, and more likely to be married (odds ratio [OR] = 1.86, 95% CI 1.02, 3.37), have BMI < 25 kg/m2 [vs. 25- < 30 kg/m2] (OR = 1.75, 95% CI 1.19, 2.58), or ≥ 1 chronic condition (OR = 1.46, 95% CI 1.06, 2.02). Never-receivers of CRC screening were less likely to be female (OR = 0.53, 95% CI 0.29, 0.96), aged 65-79y [vs. ≥ 80y] (OR = 0.61, 95% CI 0.40, 0.92), live in 5 + member households (OR = 0.33, 95% CI 0.13, 0.86), disabled (OR = 0.45, 0.22, 0.92), with purchased health insurance (OR = 0.56, 95% CI 0.33, 0.98), or report alcohol-use disorder (OR = 0.10, 95% CI 0.02, 0.49) and/or HIV/AIDS (OR = 0.28, 95% CI 0.12, 0.68). CONCLUSION Nearly 55% of low-income U.S. Veterans reported ever screening for CRC. Variations in CRC-screening behaviors according to veteran characteristics highlight potential disparities as well as opportunities for targeted behavioral interventions.
Collapse
Affiliation(s)
- Hind A Beydoun
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA.
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Jack Tsai
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
2
|
Shokar NK, Dwivedi A, Molokwu JC. Psychosocial Risk Profiles and Colorectal Cancer Screening: A Latent Profile Analysis in a Colorectal Cancer Screening Intervention Setting. Cancer Prev Res (Phila) 2023; 16:571-579. [PMID: 37550080 DOI: 10.1158/1940-6207.capr-23-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/20/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
Health behavior theories have identified predictors of colorectal cancer screening. This study aimed to determine the psychosocial profiles of a predominantly Hispanic population of primarily Mexican origin receiving a colorectal cancer screening intervention and whether a specific combination of psychosocial profiles modified the effect of colorectal cancer screening intervention on colorectal cancer screening uptake.A total of 467 participants aged 50 to 75 years due for colorectal cancer screening received an educational intervention. Latent profile analysis (LPA) was performed on baseline psychosocial constructs to identify the homogenous clustering of individuals with similar psychosocial constructs. In addition, colorectal cancer screening rates and changes in psychosocial scores between the latent groups were compared.Three psychosocial profiles, including a low benefit and high susceptibility group (LBHS), a high benefit and low susceptibility group (HBLS), and a high barrier and high susceptibility group (HBHS), were identified in this study. The HBLS group had the lowest susceptibility, with no improvement in benefits and barriers. This group had the lowest screening rate (80.85%) compared with 88.8% in LBHS and 86.3% in HBHS following the intervention. Finally, the intervention effect size on psychosocial score changes was smaller in HBLS than in other groups.This subgroup analysis suggests that colorectal cancer educational interventions should be tailored to improve the benefits and barriers among individuals with high susceptibility scores. PREVENTION RELEVANCE This LPA analysis provides some direction for tailoring colorectal cancer educational interventions to improve the benefits and barriers among individuals with high susceptibility scores in hard-to-screen populations such as our border population.
Collapse
Affiliation(s)
- Navkiran K Shokar
- Department of Population Health Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Alok Dwivedi
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Jennifer C Molokwu
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| |
Collapse
|
3
|
van Liere ELSA, Jacobs IL, Dekker E, Jacobs MAJM, de Boer NKH, Ramsoekh D. Colonoscopy surveillance in Lynch syndrome is burdensome and frequently delayed. Fam Cancer 2023; 22:403-411. [PMID: 37171677 PMCID: PMC10176312 DOI: 10.1007/s10689-023-00333-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023]
Abstract
Individuals with Lynch syndrome have an increased colorectal cancer risk, hence, biennial colonoscopy surveillance is recommended. We aimed to investigate patients' perception and preferences regarding surveillance, and to further explore compliance behaviour. Individuals with Lynch syndrome received a validated survey evaluating experiences of their three most recent colonoscopies. Individuals were non-compliant to surveillance if the interval between colonoscopies differed ≥ 6 months from the recommended interval. In total, 197 of 291 (68%) invited individuals returned the survey. They mostly underwent colonoscopy biennially (99%), under mild sedation (79%) and with bowel preparation performed by Moviprep® (99%). Surveillance was perceived as impacting quality of life in 21%, and as moderately to extremely burdensome in 57%, particularly in those below age 40. To lower the burden, patients prioritised improvements in volume and taste of bowel preparation, laxation-related bowel movements, waiting times, and a more personal and respectful approach of endoscopic staff. Additionally, many individuals (60%) would favour less-invasive surveillance modalities such as biomarkers. In total, 28% of individuals had delayed colonoscopy surveillance, predominantly for patient-related reasons. An additional 10% considered quitting/postponing surveillance. Upon multivariable analysis, patient-related delay was associated with low and medium education, history of ≤ 4 colonoscopies and having no hospital recall-system. Colonoscopy surveillance in Lynch syndrome is often experienced as burdensome, and frequently delayed. We identified determinants of surveillance behaviour in this population, and present potential interventions to reduce the burden and non-compliance rates.
Collapse
Affiliation(s)
- Elsa L S A van Liere
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands.
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Imke L Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maarten A J M Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dewkoemar Ramsoekh
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Yang MM, Usiskin K, Ahmad HA, Ather S, Sreih A, Canavan JB, Farraye FA, Ma C. Considerations for Colorectal Neoplasia Detection in Inflammatory Bowel Disease Clinical Trials. Dig Dis 2023; 42:12-24. [PMID: 37757769 PMCID: PMC10836758 DOI: 10.1159/000533395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/25/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND High-quality colonoscopic surveillance can lead to earlier and increased detection of colorectal neoplasia in patients with inflammatory bowel disease (IBD). In IBD clinical trials, endoscopy is used to assess mucosal disease activity before and after treatment but also provides an opportunity to surveil for colorectal neoplasia during follow-up. SUMMARY Best practices for colorectal cancer identification in IBD clinical trials require engagement and collaboration between the clinical trial sponsor, site endoscopist and/or principal investigator, and central read team. Each team member has unique responsibilities for maximizing dysplasia detection in IBD trials. KEY MESSAGES Sponsors should work in accordance with scientific guidelines to standardize imaging procedures, design the protocol to ensure the trial population is safeguarded, and oversee trial conduct. The site endoscopist should remain updated on best practices to tailor sponsor protocol-required procedures to patient needs, examine the mucosa for disease activity and potential dysplasia during all procedures, and provide optimal procedure videos for central read analysis. Central readers may detect dysplasia or colorectal cancer and a framework to report these findings to trial sponsors is essential. Synergistic relationships between all team members in IBD clinical trials provide an important opportunity for extended endoscopic evaluation and colorectal neoplasia identification.
Collapse
Affiliation(s)
- Mira M Yang
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Keith Usiskin
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Harris A Ahmad
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Shabana Ather
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Antoine Sreih
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - James B Canavan
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, Jacksonville, Florida, USA
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Medical Research and Development, Alimentiv Inc (formerly Robarts Clinical Trials, Inc.), London, Ontario, Canada
| |
Collapse
|
5
|
Vemulapalli KC, Lahr RE, Rex DK. 2021 Patient Perceptions Regarding Colonoscopy Experience. J Clin Gastroenterol 2023; 57:400-403. [PMID: 35324481 DOI: 10.1097/mcg.0000000000001689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/07/2022] [Indexed: 12/10/2022]
Abstract
GOAL We sought to document patient perceptions in 2021 regarding colonoscopy experience and potential deterrents to repeat colonoscopy. BACKGROUND AND AIM Bowel preparation has been previously considered by patients to be the worst part of a colonoscopy. MATERIALS AND METHODS We conducted a prospective survey of consecutive patients age 18 years and older who had just completed colonoscopy at 2 outpatient endoscopy centers at a tertiary academic hospital. The short survey was conducted in the recovery area. The main outcome measure was patient perceptions of the worst part of their colonoscopy experience and which factor would most deter them from a future colonoscopy. RESULTS Four hundred patients completed the survey of 405 approached. Average patient age was 64 years, and 48% were women. Seventy-five percent of patients used low-volume preparations. Bowel preparation was considered the worst part of colonoscopy by 71% of patients. Women were more likely to choose laxatives as the worst part of a colonoscopy. Bowel preparation was chosen most often (55%) as the most likely deterrent to a future colonoscopy. There were minimal differences in responses between those receiving low-volume versus high-volume (4 L) preparations. CONCLUSION Bowel preparation remains the worst part of the colonoscopy experience for patients, and the most likely deterrent to future colonoscopy.
Collapse
Affiliation(s)
- Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | | | | |
Collapse
|
6
|
Zessner-Spitzenberg J, Waldmann E, Ferlitsch M. [Quality Assurance of Screening Colonoscopy in Austria and Europe]. JOURNAL FUR GASTROENTEROLOGISCHE UND HEPATOLOGISCHE ERKRANKUNGEN 2022; 20:103-112. [PMID: 36320614 PMCID: PMC9610308 DOI: 10.1007/s41971-022-00137-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/05/2022]
Abstract
Die Vorsorgekoloskopie als effizientes Tool zur Reduktion von Kolorektalkarzinominzidenz und -mortalität ist nur dann effektiv, wenn sie unter hohen Qualitätsstandards durchgeführt wurde. Die European Society for Gastrointestinal Endoscopy gibt hierbei Key Performance Measures, wie die Adenomentdeckungsrate, die Zökumerreichsrate und die Rate an adäquater Vorbereitungsqualität, vor, auf die beim Screening geachtet werden sollten. Das „Qualitätszertifikat Darmkrebsvorsorge“, das als Qualitätssicherungsprogramm auf freiwilliger Basis von der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie gemeinsam mit dem Dachverband der österreichischen Sozialversicherungsträger und der Österreichischen Krebshilfe für Endoskopiker:innen in ganz Österreich ins Leben gerufen wurde, überprüft diese Qualitätsparameter. Es wird ein Darmkrebsscreening auf höchsten Standards angestrebt, um somit die besten Outcomes für Patient:innen zu erzielen. Auch europaweit ist das Interesse an einer qualitätsgesicherten Vorsorgekoloskopie groß: Viele Länder, wie z. B. die Niederlande, Norwegen und das Vereinigte Königreich haben Programme, um die Qualität des Screenings zu überwachen und zu verbessern.
Collapse
Affiliation(s)
- Jasmin Zessner-Spitzenberg
- Klinische Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18–20, 7i, 1090 Wien, Österreich
- Arbeitsgruppe Qualitätssicherung, Österreichische Gesellschaft für Gastroenterologie und Hepatologie, Wien, Österreich
| | - Elisabeth Waldmann
- Klinische Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18–20, 7i, 1090 Wien, Österreich
- Arbeitsgruppe Qualitätssicherung, Österreichische Gesellschaft für Gastroenterologie und Hepatologie, Wien, Österreich
| | - Monika Ferlitsch
- Klinische Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18–20, 7i, 1090 Wien, Österreich
- Arbeitsgruppe Qualitätssicherung, Österreichische Gesellschaft für Gastroenterologie und Hepatologie, Wien, Österreich
- Abteilung für Innere Medizin II, Gastroenterologie und Hepatologie, Evangelisches Krankenhaus Wien, Wien, Österreich
| |
Collapse
|
7
|
Colorectal Cancer and Polyp Detection Using a New Preparation-Free, Colon-Scan Capsule: A Pilot Study of Safety and Patient Satisfaction. Dig Dis Sci 2022; 67:4070-4077. [PMID: 34708286 DOI: 10.1007/s10620-021-07289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/12/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Current strategies to prevent colorectal cancer (CRC) vary considerably regarding safety, invasiveness, and patient satisfaction. A known deterrent for patients is the required bowel cleansing for colonoscopy. A new colon-scan capsule system is a unique preparation-free approach that provides structural information on colonic mucosa intended for detection of colorectal polyps and masses. AIMS The aim of this study was to determine safety and patient satisfaction with the colon-scan capsule. METHODS Prospective single-arm pilot study conducted at two tertiary care centers. Patients with a pre-scheduled colonoscopy for CRC screening or surveillance were included. Patients participating in this study underwent the colon-scan capsule and colonoscopy. Safety was defined by the occurrence of procedure or device-related adverse events. Satisfaction was based on survey questionnaires using a scoring system 1 (strongly disagree) to 5 (strongly agree). Patient satisfaction with the colon-scan capsule was compared to colonoscopy. RESULTS Forty patients were included (52.9 [5.7] years; 64.1% females). There were no serious adverse events and no occurrences of capsule retention. The most common (12.5%) complaint was self-limiting abdominal cramping. Satisfaction questionnaires were completed by more than 87% of patients, with patients likely to recommend the capsule (score 4.1 [1.03]) compared to colonoscopy (score 2.8 [1.2]), p = 0.001. CONCLUSIONS The new prepless colon-scan capsule system is an innovative, minimally invasive technology with demonstrated safety and high patient satisfaction. A multicenter pivotal study is planned to validate the performance, safety, and accuracy of polyp detection using the capsule system in comparison with colonoscopy.
Collapse
|
8
|
Mistretta F, Damiani N, Campanella D, Mazzetti S, Gulino A, Cappello G, Regge D. Effect of dose splitting of a low-volume bowel preparation macrogol-based solution on CT colonography tagging quality. Radiol Med 2022; 127:809-818. [PMID: 35715681 PMCID: PMC9349139 DOI: 10.1007/s11547-022-01514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
Purpose To compare examination quality and acceptability of three different low-volume bowel preparation regimens differing in scheduling of the oral administration of a Macrogol-based solution, in patients undergoing computed tomographic colonography (CTC). The secondary aim was to compare CTC quality according to anatomical and patient variables (dolichocolon, colonic diverticulosis, functional and secondary constipation). Methods One-hundred-eighty patients were randomized into one of three regimens where PEG was administered, respectively: in a single dose the day prior to (A), or in a fractionated dose 2 (B) and 3 days (C) before the examination. Two experienced radiologists evaluated fecal tagging (FT) density and homogeneity both qualitatively and quantitatively by assessing mean segment density (MSD) and relative standard deviation (RSD). Tolerance to the regimens and patient variables were also recorded. Results Compared to B and C, regimen A showed a lower percentage of segments with inadequate FT and a significantly higher median FT density and/or homogeneity scores as well as significantly higher MSD values in some colonic segments. No statistically significant differences were found in tolerance of the preparations. A higher number of inadequate segments were observed in patients with dolichocolon (p < 0.01) and secondary constipation (p < 0.01). Interobserver agreement was high for the assessment of both FT density (k = 0.887) and homogeneity (k = 0.852). Conclusion The best examination quality was obtained when PEG was administered the day before CTC in a single session. The presence of dolichocolon and secondary constipation represent a risk factor for the presence of inadequately tagged colonic segments.
Collapse
Affiliation(s)
| | - Nicolò Damiani
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Delia Campanella
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Simone Mazzetti
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessia Gulino
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Giovanni Cappello
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Daniele Regge
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| |
Collapse
|
9
|
Kim JH, Park YE, Kim TO, Park J, Oh GM, Moon W, Park SJ. Comparison of the efficacy and safety between oral sulfate tablet and polyethylene glycol for bowel preparation before colonoscopy according to age. Medicine (Baltimore) 2022; 101:e29884. [PMID: 35801801 PMCID: PMC9259131 DOI: 10.1097/md.0000000000029884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recently, a novel oral sulfate tablet (OST) has been introduced for bowel preparation before colonoscopy. However, whether elderly patients can take OST is not yet clear, as OST consists of 28 tablets. We aimed to compare the efficacy and safety of OST and polyethylene glycol (PEG) for bowel preparation for colonoscopy according to age. METHODS We randomly divided subjects into an OST group and a PEG group and compared Boston Bowel Preparation Score (BBPS), bubble score, patient compliance and satisfaction, and safety between the 2 groups according to age (under 65 years of age vs 65 years of age and older). RESULTS Among the 179 participants, 61 were 65 years of age and older. The BBPS and bubble score of the OST group were better than that of the PEG group, regardless of age. The satisfaction of the OST group was better than that of the PEG group, regardless of age. The compliance was not different between the 2 groups; however, the OST group under 65 years of age had a higher rate of completing the dose within 2 hours compared with the PEG group under 65 years of age. Adverse events including abdominal distension, abdominal pain, nausea, or vomiting were not different between the 2 groups. CONCLUSION The use of OST for bowel preparation before colonoscopy is as effective and safe as PEG, and these results were consistent in elderly people 65 years of age and older.
Collapse
Affiliation(s)
- Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yong Eun Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jongha Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Gyu Man Oh
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
- *Correspondence: Seun Ja Park, Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan 49267, Korea (e-mail: )
| |
Collapse
|
10
|
Bednarska O, Nyhlin N, Schmidt PT, Johansson GW, Toth E, Lindfors P. The Effectiveness and Tolerability of a Very Low-Volume Bowel Preparation for Colonoscopy Compared to Low and High-Volume Polyethylene Glycol-Solutions in the Real-Life Setting. Diagnostics (Basel) 2022; 12:diagnostics12051155. [PMID: 35626310 PMCID: PMC9140572 DOI: 10.3390/diagnostics12051155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/30/2022] [Accepted: 04/30/2022] [Indexed: 02/04/2023] Open
Abstract
Adequate bowel cleansing is essential for high-quality colonoscopy. Recently, a new very low-volume 1 litre (1L) polyethylene glycol (PEG) plus ascorbate solution (ASC) has been introduced. Our aims were to assess the effectiveness and tolerability of this product compared to low-volume 2L PEG-ASC and high-volume 4L PEG solutions, in a real-life setting. In six endoscopy units in Sweden, outpatients undergoing colonoscopy were either prescribed solutions according to local routines, or the very low-volume solution in split dose regimen. Bowel cleansing effectiveness and patient experience was assessed using the Boston Bowel preparation scale (BBPS) and a patient questionnaire. A total of 1098 patients (mean age 58 years, 52% women) were included. All subsegment and the total BBPS scores were significantly greater for 1L PEG-ASC in comparison to other solutions (p < 0.05 for 1L PEG-ASC and 4L PEG for transverse and left colon, otherwise p < 0.001). Nausea was more frequent with 1L PEG-ASC compared to 2L PEG-ASC (p < 0.001) and vomiting were more often reported compared to both other solutions (p < 0.01 and p < 0.05 for 2L PEG-ASC and 4L PEG, respectively). Smell, taste, and total experience was better for 1L PEG-ASC compared to 4L PEG (p < 0.001), and similar compared to the 2L PEG-ASC. In conclusion, 1L PEG-ASC leads to better bowel cleansing compared to 2L PEG-ASC or 4L PEG products, with similar or greater patient satisfaction.
Collapse
Affiliation(s)
- Olga Bednarska
- Department of Gastroenterology, Linköping University Hospital, S-581 85 Linköping, Sweden
- Correspondence: (O.B.); (N.N.); Tel.: +46-19-6022361 (N.N.)
| | - Nils Nyhlin
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, S-701 85 Örebro, Sweden
- Correspondence: (O.B.); (N.N.); Tel.: +46-19-6022361 (N.N.)
| | - Peter Thelin Schmidt
- Department of Medicine, Ersta Hospital, S-116 91 Stockholm, Sweden; or
- Department of Medicine, Karolinska Institutet, S-171 77 Solna, Sweden
| | - Gabriele Wurm Johansson
- Department of Gastroenterology, Skåne University Hospital, Lund University, S-205 02 Malmö, Sweden; (G.W.J.); (E.T.)
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, S-205 02 Malmö, Sweden; (G.W.J.); (E.T.)
| | - Perjohan Lindfors
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, S-171 77 Solna, Sweden; or
- Aleris Gastromottagningen City, S-111 37 Stockholm, Sweden
| |
Collapse
|
11
|
Passi M, Rahman F, Koh C, Kumar S. Efficacy and tolerability of colonoscopies in overweight and obese patients: Results from a national database on gastrointestinal endoscopic outcomes. Endosc Int Open 2022; 10:E311-E320. [PMID: 35433209 PMCID: PMC9010095 DOI: 10.1055/a-1672-3525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 09/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background and study aims Gastroenterologists are encountering a rising number of obese patients requiring colonoscopy. Existing literature regarding colonoscopy outcomes in this population is scant and conflicting. We analyzed a nationwide cohort of patients to identify the effects of body mass index (BMI) on colonoscopy success, efficacy, and tolerability. Patients and methods The Clinical Outcomes Research Initiative (CORI) endoscopic database was queried for all colonoscopies in adults between 2008-2014. Patients were stratified into four cohorts based on BMI classification for comparison. Multivariable analysis was performed to identify the effect of BMI on procedure outcome, efficacy and tolerability. Results Of 41,401 procedures, 27,696 met study inclusion criteria. Of these, 49.4 % were performed for colorectal cancer screening, most commonly under anesthesia directed sedation. Patient discomfort was the reason for an incomplete colonoscopy in 18.7 % of all cases, and more frequent among the overweight and obese cohorts. An inadequate bowel preparation was most common in the class III obesity cohort. Compared to the normal BMI group, a BMI ≥ 30 and < 40 kg/m 2 was associated with an increased odds of an incomplete colonoscopy ( P = 0.001for overweight, P = 0.0004 for class I/II obesity), longer procedure ( P < 0.05 for all) and poorer tolerance ( P < 0.0001 for class I/II obesity, P = 0.016 for class III obesity). Anesthesia-administered sedation was more commonly used than endoscopist directed sedation amongst the obese cohort compared with the normal BMI cohort ( P < 0.0001). Conclusions Endoscopists should consider the increased odds of incomplete colonoscopy, longer procedures, and poorer tolerance when performing colonoscopy in obese patients to improve clinical management and procedural outcome.
Collapse
Affiliation(s)
- Monica Passi
- Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Farial Rahman
- Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Christopher Koh
- Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Sheila Kumar
- Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
| |
Collapse
|
12
|
Fatima H, Imperiale T. Safety Profile of Endoscopist-directed Balanced Propofol Sedation for Procedural Sedation: An Experience at a Hospital-based Endoscopy Unit. J Clin Gastroenterol 2022; 56:e209-e215. [PMID: 34739402 DOI: 10.1097/mcg.0000000000001630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/27/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Nurse-administered propofol sedation was restricted to anesthesiologists in 2009, a practice that has contributed to spiraling health care costs in the United States. AIM The aim of this study was to evaluate the safety of endoscopist-directed balanced propofol sedation (EDBPS). MATERIALS AND METHODS We identified patients undergoing endoscopy with EDBPS from January 1, 2017, to June 20, 2017, and abstracted their medical records. Adverse events (AEs) included: hypoxia (oxygen saturation < 90%); hypotension [(a) systolic blood pressure < 90 mm Hg, (b) systolic blood pressure decline of >50 mm Hg, (c) decline in mean arterial pressure of >30%]; bradycardia (heart rate of < 40 beats/min). Logistic regression identified factors independently associated with AEs. RESULTS A total of 1897 patients received EDBPS during the study period [mean age: 55 y (SD=11.4 y); 56.4% women]. Patients received median doses of 50 µg fentanyl, 2 mg of midazolam, and a mean propofol dose of 160±99 mg. There were no major complications (upper 95% confidence interval, 0.19%). Overall, 334 patients (17.6%) experienced a clinically insignificant AE: 65 (3.4%) experienced transient hypoxia, 277 patients (14.6%) experienced hypotension, 2 had transient bradycardia. In bivariate analysis, older age was associated with risk for hypotension, propofol dose was associated with transient hypoxemia, and procedure duration was associated with both hypotension and transient hypoxia. In multivariate analysis, only procedure length was associated with AEs (odds ratio scale 10; odds ratio=1.07; 95% confidence interval, 1.05-1.09, P<0.001). CONCLUSIONS EDBPS is safe for endoscopic sedation. Given the higher cost of anesthesia-administered propofol, endoscopists should reinstate EDBPS by revising institutional sedation policies.
Collapse
Affiliation(s)
- Hala Fatima
- Division of Gastroenterology/Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | |
Collapse
|
13
|
A Phase 2 Randomized Trial of DCL-101, a Novel Pill-Based Colonoscopy Prep, vs 4L Polyethylene Glycol-Electrolyte Solution. Clin Transl Gastroenterol 2021; 11:e00264. [PMID: 33512795 PMCID: PMC7678801 DOI: 10.14309/ctg.0000000000000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION: DCL-101, a novel Pill Prep, is compositionally identical to standard 4L polyethylene glycol-electrolyte solution (PEG-ELS) and delivers the salt encapsulated, with PEG 3350 coadministered as a taste-free oral solution. The aim of this study was to compare the safety, taste, and tolerability of DCL-101 with 4L PEG-ELS in outpatients preparing for colonoscopy, with a secondary objective to assess efficacy. METHODS: This was a multicenter, randomized, investigator-blinded, phase 2 clinical trial of 45 adult patients undergoing outpatient colonoscopy. Patients were randomized 2:1 to either DCL-101 (3L in cohort 1; 4L in cohort 2) or 4L PEG-ELS, each administered with split dosing. Safety was assessed over 3 post-treatment clinic visits. Tolerability was measured using the Lawrance Bowel-Preparation Tolerability Questionnaire and the Mayo Clinic Bowel Prep Tolerability Questionnaire. Efficacy was determined by expert central readers, blinded to treatment, using the Ottawa Bowel Preparation Quality Scale, Boston Bowel Preparation Scale, and Aronchick scale. RESULTS: Both DCL-101 doses had superior taste and tolerability relative to 4L PEG-ELS. All adverse events were grade 1 with no significant differences in adverse events among the 3 regimens. There were no significant differences in efficacy among the 3 treatments as defined by the centrally read Ottawa Bowel Preparation Quality Scale, Boston Bowel Preparation Scale, or Aronchick scores. There were no inadequate preps as judged by the site endoscopist. DISCUSSION: DCL-101 Pill Prep is a novel strategy that vastly improves the taste and tolerability of PEG-ELS solutions with safety and efficacy comparable with split-dose 4L PEG-ELS solutions.
Collapse
|
14
|
Liu FX, Wang L, Yan WJ, Zou LC, Cao YA, Lin XC. Cleansing efficacy and safety of bowel preparation protocol using sodium picosulfate/magnesium citrate considering subjective experiences: An observational study. World J Clin Cases 2021; 9:3586-3596. [PMID: 34046458 PMCID: PMC8130092 DOI: 10.12998/wjcc.v9.i15.3586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Research data from patient reports indicate that the least bearable part of colonoscopy is the administration of laxatives for bowel preparation.
AIM To observe the intestinal cleansing efficacy and safety of sodium picosulfate/magnesium citrate and to discuss the patients’ experiences due to the procedure.
METHODS Subjects hospitalized in the International Medical Center Ward of Peking University International Hospital, Beijing, China, from April 29 to October 29, 2020, for whom the colonoscopy was planned, were enrolled. Bowel preparation was performed using sodium picosulfate/magnesium citrate. The effect of bowel cleansing was evaluated according to the Ottawa Bowel Preparation Scale, defecation conditions and adverse reactions were recorded, and the comfort level and subjective satisfaction concerning medication were evaluated by the visual analogue scale/score (VAS).
RESULTS The bowel preparation procedure was planned for all patients enrolled, which included 42 males and 22 females. The results showed an average liquid rehydration volume of 3000 mL, an average onset of action for the first dose at 89.04 min, an average number of bowel movements of 4.3 following the first dose, an average onset of action for the second dose at 38.90 min and an average number of bowel movements of 5.0 after the second dose. The total average Ottawa Bowel Preparation Scale score was 3.6, with 93.55% of bowel preparations in the “qualified” and 67.74% in the “excellent” grade. The average VAS score of effect on sleep was 0, and the average VAS score of perianal pain was also 0. The average VAS score for ease of taking and taste perception of the bowel cleanser was 10. Side effects included mild to moderate nausea (15.63%), mild vomiting (4.69%), mild to moderate abdominal pain (7.81%), mild to moderate abdominal distension (20.31%), mild palpitation (7.81%) and mild dizziness (4.69%).
CONCLUSION Sodium picosulfate/magnesium citrate is effective and safe for bowel preparation before colonoscopy with high subjective patient acceptance, thus improving overall patient compliance.
Collapse
Affiliation(s)
- Fang-Xun Liu
- Department of International Medical Center, Peking University International Hospital, Beijing 102206, China
| | - Li Wang
- Department of Gastroenterology, Peking University International Hospital, Beijing 102206, China
| | - Wen-Jie Yan
- Department of International Medical Center, Peking University International Hospital, Beijing 102206, China
| | - Li-Chun Zou
- Department of International Medical Center, Peking University International Hospital, Beijing 102206, China
| | - Yue-An Cao
- Department of International Medical Center, Peking University International Hospital, Beijing 102206, China
| | - Xiang-Chun Lin
- Department of Gastroenterology, Peking University International Hospital, Beijing 102206, China
| |
Collapse
|
15
|
Cash BD, Moncrief MBC, Epstein MS, Poppers DM. Patient experience with NER1006 as a bowel preparation for colonoscopy: a prospective, multicenter US survey. BMC Gastroenterol 2021; 21:70. [PMID: 33588763 PMCID: PMC7885614 DOI: 10.1186/s12876-021-01605-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND NER1006 (Plenvu®, Salix Pharmaceuticals, Bridgewater, NJ) is a 1 L polyethylene glycol bowel preparation indicated for colonoscopy in adults. A US online survey assessed real-world ease of use and treatment satisfaction in individuals who received NER1006. METHODS Adults were recruited from 444 US community gastrointestinal practices and provided a kit number for enrollment into an online survey to be completed within 2 weeks. Survey questions evaluated colonoscopy history and prior bowel preparation(s) prescribed, patient experience during NER1006 administration, and patient satisfaction with the bowel preparation process. A 9-point predefined grading scale was used to evaluate ease of NER1006 preparation and consumption (range, 1 "very difficult" to 9 "very easy"); the perceived importance of volume requirement and clear liquid options (range, 1 "not important at all" to 9 "very important"); and patient satisfaction (range, 1 "not satisfied at all" to 9 "very satisfied"). RESULTS 1630 patients were enrolled, 1606 underwent colonoscopy, and 1598 completed the survey between September 15, 2018 and February 28, 2019. Among 1606 patients who had a colonoscopy, 62.5% were female, and the mean patient age was 54.4 years (range 18-89 years). Most patients (74.7%) did not report a family history of colon cancer, 62.6% had undergone prior colonoscopy, and 64.8% were undergoing colonoscopy for routine colorectal cancer screening. A majority (76.1%) of patients who completed the survey reported that NER1006 was very easy to prepare and take, and 89.9% were very or moderately satisfied with NER1006 overall. Most (97.6%) patients reported consuming all or most of the bowel preparation. Among 1005 patients with previous bowel preparation use, 84.7% indicated that their experience with NER1006 was much better or better (65.3%) or about the same (19.4%) compared with previously used bowel preparations, while only 15.3% rated NER1006 as worse or much worse. CONCLUSIONS In this first real-world, US multicenter survey, patient-reported experience with NER1006 as a bowel preparation for colonoscopy was favorable and adherence was high. The majority of patients were very or moderately satisfied with the overall experience and found it much better/better than previously used bowel preparations. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Brooks D Cash
- University of Texas Health Science Center, Houston, USA.
| | | | - Michael S Epstein
- Investigative Clinical Research and Digestive Disorders Associates, Annapolis, MD, USA
| | | |
Collapse
|
16
|
Kingston-Smith H, Gunaratne AW, Saxon J, Ramrakha S, Dawson MVM, Clancy A, Wettstein A, Borody TJ. A Comparative Clinical Study of a Novel Pre-colonoscopy Bowel Capsule Preparation Against Two Commercially Available Liquid Preparations. FRONTIERS IN MEDICAL TECHNOLOGY 2021; 2:622252. [PMID: 35047898 PMCID: PMC8757798 DOI: 10.3389/fmedt.2020.622252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/29/2020] [Indexed: 12/23/2022] Open
Abstract
Background and Aims: Colonoscopy surveillance depends on effective bowel preparation. Inadequate bowel preparation can lead to inaccurate clinical diagnosis, insufficient visualization of the colon and increased risk of missed diagnosis. This study aimed to compare the efficacy and safety of a novel Capsule Bowel Preparation (RitePrep), high-volume (2L) polyethylene glycol electrolyte solution (MoviPrep®) and low-volume (1L) polyethylene glycol electrolyte solution (Plenvu™). Methods: Patients (n = 120) were divided into three groups and were administered either RitePrep, MoviPrep® or Plenvu™ as a pre-colonoscopy bowel preparation followed by a colonoscopy at a single center. Validated Boston Bowel Preparation Score (BBPS) and bubble score were used to evaluate bowel cleanliness. Blood tests were also evaluated. The scores and the blood results were analyzed using Kruskal-Wallis and Chi-squared tests. Results: A total of 120 patients (median age of 55; 57 males) [RitePrep (n = 40), MoviPrep® (n = 40) and Plenvu™ (n = 40)] were included in the study. RitePrep was the most effective method for cleansing the bowel, with a significantly higher median BBPS compared to MoviPrep® and Plenvu™ (p = 0.006 and 0.024, respectively). Nearly 50% of the patients in Plenvu™ group showed increased serum osmolality disturbance. Nausea and vomiting were higher in Plenvu™ and MoviPrep® groups than RitePrep group. Conclusions: RitePrep was demonstrated to be a more effective and safe preparation than the other two preparations. RitePrep was not only well-tolerated by all patients; the preparation sufficiently cleared the ascending, transverse, and descending colon, enabling optimal visualization for the clinician. RitePrep was also much safer than the comparators, with no alteration in electrolytes measured. For both the clinician and the patient, RitePrep was the preferred preparation.
Collapse
|
17
|
Is the choice of anesthesia during gastrointestinal endoscopic procedures a result of anxiety? Arab J Gastroenterol 2021; 22:56-60. [PMID: 33551348 DOI: 10.1016/j.ajg.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/08/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) are vital endoscopic procedures in the diagnosis and follow-up of gastrointestinal tract diseases. Endoscopic procedures can be performed with or without anesthesia as per patient preferences. These procedures can cause some anxiety in almost all patients, and the degree of anxiety differs for each individual. Thus, we aimed to evaluate the trait and state anxiety levels of the patients and assess the relationship between the preference of anesthesia and anxiety levels. PATIENTS AND METHODS To investigate this issue, 723 patients who underwent elective endoscopy (EGD and/or CS) were enrolled. The researchers collected sociodemographic data and medical history records as reported by the patients. State and trait anxiety levels of the patients were evaluated using the State and Trait Anxiety Inventory (STAI). RESULTS The patients were divided into two groups as with anesthesia and without anesthesia. Of the respondents, 43.4% requested anesthesia during endoscopic procedure. Sociodemographic data, except sex, showed similar characteristics. The STAI trait scores of the two groups were similar; however, there was a significant difference in the STAI state scores of the groups (p = 0.018). A significant difference was observed in the anesthesia preference and the type of endoscopic procedure (EGD, CS, or both) (p < 0.001). Type of endoscopic procedure, STAI state scores, and sex were determined as the predictors of the anesthesia choice. CONCLUSION Endoscopic procedures are known to cause anxiety among many patients. Our findings suggest that the anesthesia preferences of patients are an important factor in preventing these situational concerns. However, this study found that being a woman and undergoing a CS procedure are important factors related to anesthesia preferences. Thus, more detailed assessments on this subject are required.
Collapse
|
18
|
Dossa F, Megetto O, Yakubu M, Zhang DDQ, Baxter NN. Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations. BMC Gastroenterol 2021; 21:22. [PMID: 33413147 PMCID: PMC7792218 DOI: 10.1186/s12876-020-01561-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures. METHODS We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded. We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. RESULTS We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations. CONCLUSIONS Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency.
Collapse
Affiliation(s)
- Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Olivia Megetto
- Ontario Health, Cancer Care Ontario, Toronto, ON, Canada
| | - Mafo Yakubu
- Ontario Health, Cancer Care Ontario, Toronto, ON, Canada
| | - David D Q Zhang
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
19
|
Gawron AJ, Staub J, Bielefeldt K. Impact of Health Insurance, Poverty, and Comorbidities on Colorectal Cancer Screening: Insights from the Medical Expenditure Panel Survey. Dig Dis Sci 2021; 66:70-77. [PMID: 32816210 DOI: 10.1007/s10620-020-06541-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/06/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite national campaigns and other efforts to improve colorectal cancer (CRC) screening, participation rates remain below targets set by expert panels. We hypothesized that availability and practice patterns of healthcare providers may contribute to this gap. METHOD Using data of the Medical Expenditure Panel Survey for the years between 2000 and 2016, we extracted demographic, socioeconomic, and health-related data as well as reported experiences about barriers to care, correlating results with answers about recent participation in colorectal cancer screening. As CRC screening guidelines recommend initiation of testing at age 50, we focused on adults 50 years or older. RESULTS We included responses of 163,564 participants for the period studied. There was a significant increase in CRC screening rates over time. Comorbidity burden, poverty, race, and ethnicity independently predicted participation in screening. Lack of insurance coverage and cost of care played an important role as reported barrier. Convenient access to care, represented by availability of appointments beyond typical business hours, and frequency of provider interactions, correlated with higher rates of screening. CONCLUSION Our data show a positive effect of educational efforts and healthcare reform with coverage of screening. Easy and more frequent access to individual providers predicted a higher likelihood of completed screening tests. This finding could translate into more widespread implementation of screening programs, as the increasingly common virtual care delivery offers a new and convenient option to patients.
Collapse
Affiliation(s)
- Andrew J Gawron
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Judith Staub
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Klaus Bielefeldt
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA.
- George E. Whalen VA Medical Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT, 84148, USA.
| |
Collapse
|
20
|
Hydro-jet propelled colonoscopy: proof of concept in a phantom colon. Surg Endosc 2020; 35:989-995. [PMID: 33090315 PMCID: PMC7819862 DOI: 10.1007/s00464-020-08089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/03/2020] [Indexed: 10/28/2022]
Abstract
BACKGROUND Colonoscopy is a widely used and effective procedure, but it often causes patient discomfort and its execution requires considerable skill and training. We demonstrate an alternative approach to colonoscope propulsion with the potential to minimise patient discomfort by reducing the forces exerted on the colonic wall and mesentery, and to reduce the level of skill required for execution. METHODS A prototype colonoscopic device is described, consisting of a tethered capsule that is propelled and manoeuvred through a water-filled colon (hydro-colonoscopy) by an array of water jets. As an initial proof of concept, experiments were performed to assess the ability of the device to navigate through a simplified PVA cryogel human colon phantom arranged in various anatomical configurations. RESULTS The prototype was capable of successfully navigating through three out of four colon configurations: a simple layout, alpha loop and reverse alpha loop. It was unable to negotiate the fourth configuration involving an "N loop", but this was attributed to problems with the colon phantom. In the successful test replicates, mean complete insertion (i.e. caecal intubation) time was 4.7 min. Measured pressures, temperatures and forces exerted on the colon appeared to be within a physiologically acceptable range. The results demonstrate the viability of propelling a colonoscope through a colon phantom using hydro-jets. CONCLUSIONS Results indicate that this approach has the potential to enable rapid and safe caecal intubation. This suggests that further development towards clinical translation is worthwhile.
Collapse
|
21
|
Al-Azri M, Al-Khatri S, Murthi Panchatcharam S. Attitudes toward and Knowledge of Colorectal Cancer Screening among an Omani Adult Population Attending a Teaching Hospital. Asian Pac J Cancer Prev 2020; 21:3061-3068. [PMID: 33112568 PMCID: PMC7798140 DOI: 10.31557/apjcp.2020.21.10.3061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 12/24/2022] Open
Abstract
Objective: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Oman after breast and thyroid. Awareness regarding the availability of CRC screening services could play a major role in promoting early detection and reducing mortality rates. The aim of this study was to identify public knowledge and attitudes toward CRC screening. Methods: This cross-sectional study was conducted among 410 members of the public attending the Sultan Qaboos University Hospital in Muscat, Oman. A questionnaire was developed to assess the participants’ general knowledge, barriers and factors affecting attitudes, beliefs and behaviors regarding CRC screening. Results: A total of 410 members of the public participated from 500 invited (response rate: 82.0%). Most of the participants had not heard of CRC screening (76.3%) and were unaware of different screening methods (92.9%). The majority (93.9%) had not undergone CRC screening in Oman; however, 70.6% reported that they would be willing to do so in the future, particularly if recommended by doctors (52.7%). Barriers to screening included feeling embarrassed by the idea of a colonoscopy (73.9%), not having any symptoms of CRC (65.1%) and a fear of being diagnosed with CRC (55.6%). A bivariate analysis indicated that males demonstrated significantly more awareness of CRC screening compared to females (64.9% versus 35.1%; p = 0.004) and younger participants (<40 years of age) were significantly more aware of CRC screening compared to their older counterparts (75.3% versus 24.7%; p = 0.025). Conclusions: The majority of public in Oman showed low knowledge and awareness of CRC screening and identified several emotional barriers that might result in poor participation should screening be considered. Public education and the involvement of healthcare professionals is paramount to the implementation of a large-scale CRC screening program in Oman. In addition, addressing the sources of emotional barriers to screening is necessary.
Collapse
Affiliation(s)
- Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences. Sultan Qaboos University, P O Box 35. Postal Code 123. Muscat, Sultanate of Oman
| | - Sharouq Al-Khatri
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | |
Collapse
|
22
|
Protopapas AA, Stournaras E, Neokosmidis G, Stogiannou D, Filippidis A, Protopapas AN. Endoscopic sedation practices of Greek gastroenterologists: a nationwide survey. Ann Gastroenterol 2020; 33:366-373. [PMID: 32624656 PMCID: PMC7315718 DOI: 10.20524/aog.2020.0494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Sedation in gastrointestinal endoscopy is rapidly evolving worldwide. However, this has led to significant disagreements, especially regarding the use of propofol by non-anesthesiologists. The aim of this study was to document the practices of Greek gastroenterologists regarding sedation and compare them to previous surveys. Methods: The study was conducted in 2 periods, December 2015 and June 2018. In each period, the same online questionnaire regarding endoscopic sedation practices was sent to all registered Greek gastroenterologists (509 and 547 gastroenterologists, respectively). Results: The response rates were 38.3% and 47.1%, respectively. In each period, 25.1% and 16.7% of physicians did not use sedation. Most gastroenterologists (approx. 70% in both instances) answered that they “almost never” collaborate with an anesthesiologist during endoscopy. Midazolam was by far the most popular sedation agent, used by almost 90% of physicians in both periods. Propofol was used by 30.8% and 27% of physicians, respectively. Physicians using propofol were significantly more satisfied with the sedation than other physicians, while propofol was the agent selected by most physicians if they were to undergo endoscopy themselves. Most physicians cited medicolegal reasons and inadequate training as chief reasons for not using propofol. Conclusions: Sedation use is widespread among Greek gastroenterologists. Although midazolam is the most commonly used agent, propofol is preferred (theoretically) by most physicians and achieves the best satisfaction. The introduction of a strict training curriculum for endoscopic sedation can effectively eliminate the barriers preventing gastroenterologists from administering propofol, while at the same time ensuring optimal patient safety during endoscopy.
Collapse
Affiliation(s)
- Adonis A Protopapas
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
| | - Evangelos Stournaras
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas).,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom (Evangelos Stournaras)
| | - Georgios Neokosmidis
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
| | - Dimitrios Stogiannou
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
| | - Athanasios Filippidis
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
| | - Andreas N Protopapas
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
| |
Collapse
|
23
|
Amlani B, Radaelli F, Bhandari P. A survey on colonoscopy shows poor understanding of its protective value and widespread misconceptions across Europe. PLoS One 2020; 15:e0233490. [PMID: 32437402 PMCID: PMC7241766 DOI: 10.1371/journal.pone.0233490] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/06/2020] [Indexed: 12/29/2022] Open
Abstract
Background Colonoscopy is a valuable screening tool for colorectal cancer. However, patients experience anxiety when faced with attending a first colonoscopy, and negative attitudes may contribute to non-attendance. Few studies in Europe have explored these attitudes, despite increasing colorectal cancer incidence. Study aim We conducted an online survey of the public in five European Union countries (France, Germany, Italy, Spain, and the UK), with the aim of understanding public knowledge of, perceptions of, and attitudes towards, colonoscopy and bowel preparation, amongst colonoscopy-naïve respondents. Attitudes towards colonoscopy were also gathered from colonoscopy-experienced patients. Methods Survey answers were gathered from 2,500 colonoscopy-naïve respondents and 500 colonoscopy-experienced patients, divided equally between countries. Results Across Europe, 72% of colonoscopy-naïve respondents showed receptiveness to colonoscopy if advised by their doctor to receive one, but only 45% understood its use to prevent colorectal cancer. Forty-three percent of colonoscopy-experienced respondents would still be embarrassed about having another colonoscopy, although 59% said that the experience had been better than expected. Colonoscopy-experienced respondents had greater aversion to bowel preparation than colonoscopy-naïve respondents (47% vs 26%), and 67% of colonoscopy-naïve respondents thought that only 1 litre of bowel preparation or less is required. Italians and the Spanish wanted more information than on average in Europe, while Germans had more realistic expectations of bowel preparation. Discussion There are perceptual gaps amongst the public around the purpose of colonoscopies, the subjective experience of the colonoscopy procedure, and the quantity of bowel preparation needed. These concerns could be mitigated by better education and using lower-volume bowel preparation techniques. Conclusion Europeans would have a colonoscopy, but its preventive medical purpose is poorly understood and there are misconceptions around the process. Further education about the procedure, its benefits and bowel preparation is vital to improve understanding and compliance.
Collapse
Affiliation(s)
- Bharat Amlani
- Norgine Ltd., Medical Affairs, Harefield, United Kingdom
| | - Franco Radaelli
- Endoscopy Unit, Department of Gastroenterology, Valduce Hospital, Como, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospital, Portsmouth, United Kingdom
| |
Collapse
|
24
|
Sharma P, Burke CA, Johnson DA, Cash BD. The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention. Endosc Int Open 2020; 8:E673-E683. [PMID: 32355887 PMCID: PMC7165013 DOI: 10.1055/a-1127-3144] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Colonoscopy for colorectal cancer (CRC) screening has reduced CRC incidence and mortality and improved prognosis. Optimal bowel preparation and high-quality endoscopic technique facilitate early CRC detection. This review provides a narrative on the clinical importance of bowel preparation for colonoscopy and highlights available bowel preparations. Methods A PubMed search was conducted through June 2019 to identify studies evaluating clinical outcomes, efficacy, safety, and tolerability associated with bowel preparation for CRC screening-related colonoscopy. Results Selecting the optimal bowel preparation regimen is based on considerations of efficacy, safety, and tolerability, in conjunction with individual patient characteristics and preferences. Available bowel preparations include high-volume (4 L) and low-volume (2 L and 1 L), polyethylene glycol (PEG) solutions, sodium sulfate, sodium picosulfate/magnesium oxide plus anhydrous citric acid, sodium phosphate tablets, and the over-the-counter preparations magnesium citrate and PEG-3350. These preparations may be administered as a single dose on the same day or evening before, or as two doses administered the same day or evening before/morning of colonoscopy. Ingesting at least half the bowel preparation on the day of colonoscopy (split-dosing) is associated with higher adequate bowel preparation quality versus evening-before dosing (odds ratio [OR], 2.5; 95 % confidence interval [CI], 1.9-3.4). Conclusions High-quality bowel preparation is integral for optimal CRC screening/surveillance by colonoscopy. Over the last 30 years, patients and providers have gained more options for bowel preparation, including low-volume agents with enhanced tolerability and cleansing quality that are equivalent to 4 L preparations. Split-dosing is preferred for achieving a high-quality preparation.
Collapse
Affiliation(s)
- Prateek Sharma
- University of Kansas Medical Center, Kansas City, Kansas, United States
| | | | - David A. Johnson
- Eastern Virginia Medical School, Norfolk, Virginia, United States
| | - Brooks D. Cash
- University of Texas Health Science Center, Houston, Texas, United States
| |
Collapse
|
25
|
Regula J, Spaander MC, Suchanek S, Kornowski A, Perrot V, Fischbach W. A European, multicentre, observational, post-authorisation safety study of oral sulphate solution: compliance and safety. Endosc Int Open 2020; 8:E247-E256. [PMID: 32140554 PMCID: PMC7055619 DOI: 10.1055/a-1090-7289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/15/2019] [Indexed: 11/24/2022] Open
Abstract
Background and study aims Oral sulphate solution (OSS) is a sulphate-based, low-volume bowel cleansing preparation taken in two doses of 500 mL, each followed by 1000mL of water or clear liquid. The primary objective of this observational study was to document compliance with the recommended hydration guidelines in a representative sample of the European population. Patients and methods Prospective, non-interventional, multicentre study (NCT02630680, EUPAS9361) in patients prescribed OSS for colonoscopy preparation in routine clinical practice in Europe. Patients were included according to pre-agreed consecutive enrolment rules. Patients recorded the volume of OSS and water or clear liquid intake, and occurrence of adverse events (AEs). Compliance with hydration was calculated as a ratio of actual volume of water/clear liquid taken versus prescribed 2,000 mL, and non-compliance defined as < 75 % intake. Colon cleansing level was assessed on a 4-point scale. Results Between October 2015 and January 2017, 1,281 patients were recruited in 16 centres in four European countries (safety population n = 1,206; registry population n = 1,177). Of patients, 94.5 % were ≥ 75 % and 86.8 % 100 % compliant with hydration guidelines. Patients took an average of 96.8 % of the recommended OSS volume; 46 patients (3.9 %) were non-compliant. Colon cleansing levels were good-to-excellent in 87.6 % of patients. Three hundred and twenty-nine patients (27.3 %) experienced 758 treatment-related AEs, mostly gastrointestinal (82.9 %), all were mild-to-moderate. Non-compliant patients had no AEs suggestive of dehydration. Conclusion In this non-interventional study in a real-life setting, treatment compliance with hydration guidelines was good-to-excellent in 94.5 % of patients receiving OSS. The safety profile of OSS was similar to the prescribing information.
Collapse
Affiliation(s)
- Jaroslaw Regula
- Medical Centre for Postgraduate Education and Maria Sklodowska-Curie Institute-Oncology Centre, Warsaw, Poland
| | - Manon C.W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stepan Suchanek
- Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague, Czech Republic
| | | | | | - Wolfgang Fischbach
- Medizinische Klinik II, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | | |
Collapse
|
26
|
Dossa F, Dubé C, Tinmouth J, Sorvari A, Rabeneck L, McCurdy BR, Dominitz JA, Baxter NN. Practice recommendations for the use of sedation in routine hospital-based colonoscopy. BMJ Open Gastroenterol 2020; 7:e000348. [PMID: 32128226 PMCID: PMC7039579 DOI: 10.1136/bmjgast-2019-000348] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/21/2022] Open
Abstract
Objective Although sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice. Design We recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus. Results Twenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients. Conclusion The recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.
Collapse
Affiliation(s)
- Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Dubé
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jill Tinmouth
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anne Sorvari
- Department of General Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Cancer Care Ontario, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Jason A Dominitz
- Department of Medicine, Division of Gastroenterology, VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, Washington, USA
| | - Nancy N Baxter
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Department of General Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| |
Collapse
|
27
|
An Intraprocedural Endoscopic Cleansing Device for Achieving Adequate Colon Preparation in Poorly Prepped Patients. J Clin Gastroenterol 2019; 53:530-534. [PMID: 30720576 DOI: 10.1097/mcg.0000000000001114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS An effective bowel preparation is essential for quality colonoscopy. Inadequate preparation results in missed lesions, need for earlier repeat procedures, prolonged colonoscopy duration, an increased likelihood of adverse events, reduced patient satisfaction, and increased costs. The MOTUS GI Pure-Vu System (Tirat Carmel, Israel) is an Food and Drug Administration-cleared device designed to improve visualization in an inadequately prepared colon by facilitating intraprocedural cleaning. We evaluated the efficacy, safety, and usability of the Pure-Vu System in cleansing poorly prepared colons in human subjects. METHODS In total, 50 patients with poorly prepared colons undergoing colonoscopy were prospectively enrolled to evaluate the Pure-Vu System at 2 clinical sites [Spain (N=41) and Israel (N=9)]. Cleansing quality was measured using the Boston Bowel Preparation Score (BBPS). RESULTS In total, 50 patients (64% male individuals), mean age 51.9±10.4 years, and mean body mass index of 26.6±3.1 were enrolled. The Pure-Vu System significantly increased the BBPS median score from 5.0 at baseline to 9.0 after the use of Pure-Vu (P<0.0001). Patients with an adequate cleansing level (BBPS≥2 in each colon segment) increased significantly from 31% (15/49) at baseline to 98% (48/49) after use of Pure-Vu (P<0.001). Cecal intubation was achieved in 48/49 (98%) patients. Colonoscopists were satisfied with the Pure-Vu System. No serious adverse events were reported. CONCLUSIONS The Pure-Vu System was found to be safe, efficacious, and easy to use in cleansing inadequately prepared colons, enabling the colonoscopist to conduct a complete examination.
Collapse
|
28
|
The Effect of Obesity on the Quality of Bowel Preparation for Colonoscopy: Results From a Large Observational Study. J Clin Gastroenterol 2019; 53:e214-e220. [PMID: 29738352 DOI: 10.1097/mcg.0000000000001045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Obesity has been linked to suboptimal bowel preparation but this association has not been conclusively investigated in prospective studies. GOALS Our objective was to determine whether any relationship exists between obesity as measured by body mass index (BMI) and quality of bowel preparation. STUDY Adult patients who presented for outpatient colonoscopy at a single urban ambulatory surgery center within a 6-month period and fulfilled inclusion criteria were prospectively enrolled for the study. Patients were divided by BMI into subcategories based on the World Health Organization international classification of obesity. The Modified Aronchick scale was used to assess bowel preparation for colonoscopy. A univariate and multivariate analysis was used to determine a possible association between BMI and poor preparation. RESULTS A total of 1429 patients were evaluated. On the basis of inclusion criteria, 1314 subjects were analyzed, out of which 73% were overweight or obese. Inadequate bowel preparation was noted in 21.1% of patients. There was no correlation between obesity and the quality of the bowel preparation. Male gender (P=0.002), diabetes mellitus (P<0.0001), liver cirrhosis (P=0.001), coronary artery disease (P=0.003), refractory constipation (P<0.0001), and current smoking (P=0.01) were found to be independently predictive of poor bowel preparation. CONCLUSIONS Increased BMI is not predictive of suboptimal bowel preparation for colonoscopy. The results of our study are pivotal given the increased risk of colorectal cancer in obese patients and their known lower rate of colorectal cancer screening in certain populations. It is important to avoid subjecting these patients to an intensive bowel preparation that may further discourage screening in a patient population that requires it.
Collapse
|
29
|
Abstract
Background: Screening for colorectal cancer (CRC) provides an effective strategy for early detection and prevention of the disease; however, global screening rates are still low. Purpose: This study aims at assessing the awareness of CRC risk factors, warning signs, and attitudes towards CRC guidelines and screening modalities, in order to identify the barriers to and correlates of CRC screening in the Lebanese population. Methods: A self-administered questionnaire was distributed to 371 participants in the largest health care medical center in Lebanon. A validated 12- and 9-item Cancer Awareness Measurement questionnaire was used to assess participants’ awareness of CRC risk factors and warning signs. Results: 83% and 67% of participants were not aware of CRC risk factors and warning signs, respectively, 15% have previously undergone CRC screening, 56% were aware of the necessity for screening, and 43% were willing to undergo screening. Factors affecting awareness of the necessity for CRC screening, past screening and willingness to screen included awareness of risk factors and warning signs, undergoing regular physician check-ups, having a family physician as a primary source of knowledge of CRC, and knowing a family member or friend diagnosed with CRC. Barriers to screening were related to participants’ evaluation of the screening technique and misconceptions about this disease. Conclusion: Serious active measures should be taken by health care sectors, authoritative groups, primary care physicians, and awareness campaigns to fill the gap in awareness of this disease and to alleviate the barriers and misconceptions around it.
Collapse
|
30
|
Gluck N, Half EE, Bieber V, Schwartz D, Ron Y, Gralnek I, Klein A, Lachter J, Levy MS, Moshkowitz M, Arber N. Novel prep-less X-ray imaging capsule for colon cancer screening: a feasibility study. Gut 2019; 68:774-775. [PMID: 29785966 DOI: 10.1136/gutjnl-2018-316127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Nathan Gluck
- Department of Gastroenterology, Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elizabeth E Half
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Vered Bieber
- Department of Gastroenterology, Ha'emek Medical Centre, Technion Institute of Technology, Haifa, Israel
| | - Doron Schwartz
- Department of Gastroenterology, Soroka Medical Center, Ben-Gurion University, Beer Sheva, Israel
| | - Yulia Ron
- Department of Gastroenterology, Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ian Gralnek
- Department of Gastroenterology, Ha'emek Medical Centre, Technion Institute of Technology, Haifa, Israel
| | - Amir Klein
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Jesse Lachter
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Moshe Shoni Levy
- Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Menachem Moshkowitz
- Department of Gastroenterology, Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Nadir Arber
- Department of Gastroenterology, Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| |
Collapse
|
31
|
Evidence of Differences and Discrimination in the Delivery of Care: Colorectal Screening in Healthy People and in the Care and Surveillance of Patients with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2019. [DOI: 10.3390/gidisord1020020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: In this review the management of colorectal disease will be investigated as an exemplar of common practice in the UK in an attempt to identify factors responsible for the more general experiences of patients from ethnic minorities. Within this field such populations have a lower uptake of cancer screening programmes and their experience of day-to-day care for chronic gastrointestinal disorders is poor. Study design: PubMed and Google Scholar were reviewed in 2016 to identify publications concerning colorectal screening in patients with inflammatory bowel disease and healthy communities. Methods: Data were extracted from each paper and the references exploded to identify other potential reports. Results: It is reported that barriers exist both at individual and access levels but little has been done to overcome these. There have been a number of suggestions as to how to provide equitable access, but there is a clear need to ensure that these are evidence based and have been tested and shown to be effective in clinical trials. Conclusions: Clearly, current systems of surveillance and screening will only make a difference if they provide effective and acceptable services to all potential clients. Most programmes fail to address the specific risks and anxieties of minority groups, which are thought to be poorly compliant. This review considers those factors that may play a part and suggests approaches that could overcome these deficiencies. Some clues as to these factors may come from work with patients with chronic disorders.
Collapse
|
32
|
Utano K, Takayanagi D, Nagata K, Aizawa M, Endo S, Nemoto T, Nemoto D, Isohata N, Lefor AK, Togashi K. A novel volume-reduced CT colonography regimen using hypertonic laxative (polyethylene glycol with ascorbic acid): randomized controlled trial. Eur Radiol 2019; 29:5236-5246. [PMID: 30903329 DOI: 10.1007/s00330-019-06127-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/10/2019] [Accepted: 02/25/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study is to investigate the feasibility of bowel preparation using a hypertonic laxative (polyethylene glycol with ascorbic acid, PEG + Asc) for CT colonography (CTC) and to examine the volume limit of laxative. METHODS In one institution, patients who met the indications for CTC were enrolled and randomly assigned to CTC with regimen A (800 ml PEG + Asc), B (600 ml PEG + Asc), or C (400 ml PEG + Asc). Sodium diatrizoate was given orally for fecal tagging. On the previous day, patients ate low-residue meals and took the assigned lavage solution after dinner. A reader blinded to the preparation graded residual stool/fluid and fecal tagging quality in six segments of the colorectum. The primary outcome was a proportion of colon segments without stool. One hundred twenty segments in 20 patients with each regimen were needed to show a non-inferiority margin of 15%, assuming 85% of no stool. RESULTS A total of 360 segments in 60 patients were analyzed. There were 83% of segments with no stool in regimen A, 89% in regimen B, and 88% in regimen C. Using the delta method, the 95% confidence interval of the risk difference (6.7%) between regimens A and B was - 2.2% to 15.6%, and the risk difference (5.0%) between regimens A and C was - 4.1% to 14%, both within the non-inferiority margin. Residual fluid and fecal tagging quality were also within the non-inferiority margin. No adverse events occurred. CONCLUSIONS A novel CTC regimen using hypertonic laxative demonstrated optimal colon cleansing effectiveness even with the lowest volume of laxative (UMIN000022851). KEY POINTS • A novel CTC regimen using a hypertonic laxative is feasible. • The lowest volume of laxative provides excellent colon imaging. • However, the lowest volume of laxative did not improve patient acceptance.
Collapse
Affiliation(s)
- Kenichi Utano
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Daisuke Takayanagi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Koichi Nagata
- Division of Screening Technology, National Cancer Center, Tokyo, Japan
| | - Masato Aizawa
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Tetsutaro Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Daiki Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Noriyuki Isohata
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan.
| |
Collapse
|
33
|
Alyabsi M, Charlton M, Meza J, Islam KMM, Soliman A, Watanabe-Galloway S. The impact of travel time on colorectal cancer stage at diagnosis in a privately insured population. BMC Health Serv Res 2019; 19:172. [PMID: 30885199 PMCID: PMC6423832 DOI: 10.1186/s12913-019-4004-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rural residents are less likely to receive screening for colorectal cancer (CRC) than urban residents. However, the mechanisms underlying this disparity, especially among people aged 50-64 years old with private health insurance, are not well understood. We examined the impact of travel time on stage at CRC diagnosis. METHODS This retrospective cohort study used data from the Blue Cross and Blue Shield of Nebraska. Members of this private insurance company aged 50-64 years, diagnosed with CRC during the period 2012-2016, and continuously enrolled in the insurance plan for at least 6 months prior to CRC diagnosis, were selected for this study. Using Google Maps, we estimated patients' travel time from their home ZIP code to the ZIP code of their colonoscopy provider. Using logistic regression, we analyzed the association between stage at CRC diagnosis, travel time, use of preventive services (i.e., check-ups or counseling to prevent or detect illness at an early stage) and patient characteristics. RESULTS A total of 307 subjects met the inclusion criteria. People who had not used preventive services 6 months prior to CRC diagnosis had 2.80 (95% CI, 1.00-7.90) times the odds of metastatic CRC compared to those who had used these services. No statistically significant association was found between travel time and metastatic CRC diagnosis (P = 0.99; 95% CI, 0.98-1.01). CONCLUSIONS The fact that 13% of the study population presented with metastatic CRC suggests some noncompliance with preventive services such as screening guidelines. To increase screening uptake and reduce metastatic cases, employers should offer incentives for their employees to make use of preventive services such as CRC screening.
Collapse
Affiliation(s)
- Mesnad Alyabsi
- Department of Population Health Research, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh, 11481, 1515 Saudi Arabia
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, Iowa, 52242 USA
| | - Jane Meza
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, 984375 Nebraska Medical Center, Omaha, NE 68198–4395 USA
| | - K. M. Monirul Islam
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, 984395 Nebraska Medical Center, Omaha, NE 68198–4395 USA
| | - Amr Soliman
- City University of New York School of Medicine, Community Health and Social Medicine, 160 Convent Avenue, New York, NY 10031 USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, 984395 Nebraska Medical Center, Omaha, NE 68198–4395 USA
| |
Collapse
|
34
|
Mitsuzaki K, Iinuma G, Morimoto T, Miyake M, Tomimatsu H. Computed tomographic colonography with a reduced dose of laxative using a novel barium sulfate contrast agent in Japan. Jpn J Radiol 2018; 37:245-254. [PMID: 30554302 DOI: 10.1007/s11604-018-0800-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/09/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To test the tagging efficacy, patient acceptability, and accuracy of computed tomographic colonography (CTC) with a reduced dose of laxative using a novel barium sulfate (BaSO4) contrast agent. MATERIALS AND METHODS CTC followed by optical colonoscopy (OC) was performed on 73 patients with positive results in fecal occult blood tests. They were administrated a BaSO4 suspension and a magnesium citrate solution for bowel preparation. Patients completed a questionnaire about the acceptability of bowel preparation. Tagging efficacy was estimated using a novel categorization system, which classified all segments into 8 categories. The accuracy of detecting protruded lesions ≥ 6 mm was calculated from the comparison of CTC and OC results, using the latter as a reference standard. RESULTS Tagging efficacy was good in 77.3% of colonic segments where residue was observed. The acceptability of bowel preparation for CTC was significantly higher than that for OC. The sensitivity, specificity, and positive and negative predictive values were 0.778, 0.945, 0.824, and 0.929, respectively. All lesions ≥ 7 mm were successfully detected by CTC. CONCLUSION CTC with a reduced dose of laxative using a novel BaSO4 contrast agent has a favorable tagging efficacy, patient acceptability, and accuracy.
Collapse
Affiliation(s)
- Katsuhiko Mitsuzaki
- Center for Preventive Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, Japan.
| | - Gen Iinuma
- Department of Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Tsuyoshi Morimoto
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Mototaka Miyake
- Department of Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Hideto Tomimatsu
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagito, Gifu, Gifu, Japan
| |
Collapse
|
35
|
Perreault G, Goodman A, Larion S, Sen A, Quiles K, Poles M, Williams R. Split- versus single-dose preparation tolerability in a multiethnic population: decreased side effects but greater social barriers. Ann Gastroenterol 2018; 31:356-364. [PMID: 29720862 PMCID: PMC5924859 DOI: 10.20524/aog.2018.0254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/22/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study was performed to compare patient-reported tolerability and its barriers in single- vs. split-dose 4-L polyethylene glycol (PEG) bowel preparation for colonoscopy in a large multiethnic, safety-net patient population. METHODS A cross-sectional, dual-center study using a multi-language survey was used to collect patient-reported demographic, medical, socioeconomic, and tolerability data from patients undergoing outpatient colonoscopy. Univariate and multivariate analyses were used to identify demographic and clinical factors significantly associated with patient-reported bowel preparation tolerability. RESULTS A total of 1023 complete surveys were included, of which 342 (33.4%) completed single-dose and 681 (66.6%) split-dose bowel preparation. Thirty-nine percent of the patients were Hispanic, 50% had Medicaid or no insurance, and 34% had limited English proficiency. Patients who underwent split-dose preparation were significantly more likely to report a tolerable preparation, with less severe symptoms, than were patients who underwent single-dose preparation. Multiple logistic regression revealed that male sex and instructions in the preferred language were associated with tolerability of the single-dose preparation, while male sex and concerns about medications were associated with tolerability of the split-dose preparation. CONCLUSIONS In a large multiethnic safety-net population, split-dose bowel preparation was significantly more tolerable and associated with less severe gastrointestinal symptoms than single-dose preparation. The tolerability of split-dose bowel preparation was associated with social barriers, including concerns about interfering with other medications.
Collapse
Affiliation(s)
- Gabriel Perreault
- Department of Medicine, New York University Langone Medical Center, New York (GabrielPerrault), USA
| | - Adam Goodman
- Division of Gastroenterology, New York University School of Medicine, New York (Adam Goodman, Kirsten Quiles, Renee Williams), USA
| | | | - Ahana Sen
- University of Texas Southwestern Medical Center, Dallas, TX (Ahana Sen), USA
| | - Kirsten Quiles
- Division of Gastroenterology, New York University School of Medicine, New York (Adam Goodman, Kirsten Quiles, Renee Williams), USA
| | - Michael Poles
- Veteran Affairs New York Harbor Healthcare System, Manhattan Campus, New York (Michael Poles), USA
| | - Renee Williams
- Division of Gastroenterology, New York University School of Medicine, New York (Adam Goodman, Kirsten Quiles, Renee Williams), USA
| |
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW This is a review of colon capsule endoscopy (CCE) with a focus on its recent developments, technological improvements, and current and potential future indications. RECENT FINDINGS Based on the current literature, CCE II demonstrates comparable polyp detection rates as optical colonoscopy and CT colonography, and improved cost-effectiveness. The main limitation to patient acceptance is the requirement of a rigorous bowel preparation. Preliminary studies show good correlation between CCE and optical colonoscopy for assessment of colonic disease activity in inflammatory bowel disease (IBD). CCE II is currently FDA, approved as an adjunctive test in patients with prior incomplete colonoscopy, and in the evaluation of patients with suspected lower gastrointestinal bleeding. The test is approved in Europe as one of the options for average-risk colorectal cancer screening, and high-risk screening in patients with contraindications or unwilling to undergo colonoscopy. CCE has a potential role in the evaluation and monitoring of colonic disease activity in IBD. Future technological advances should focus on minimizing bowel preparation, improvement in reading times, and development of therapeutic capabilities. • With technological improvements, the second-generation colon capsule has a significantly higher sensitivity than the first-generation capsule for detection of colon polyps. • Colon capsule endoscopy has been approved in Europe as an option for average-risk colorectal cancer screening, and high-risk screening in patients with contraindications or unwilling to undergo colonoscopy. • Colon capsule endoscopy has received FDA approval as an option for colorectal cancer screening in patients with prior incomplete colonoscopy, and in evaluation of patients with suspected lower gastrointestinal bleeding. • Colon capsule endoscopy may have a role in evaluation and monitoring of inflammatory bowel disease. • Colon capsule endoscopy currently requires a bowel preparation that is more rigorous than colonoscopy.
Collapse
Affiliation(s)
- Shabana F Pasha
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
| |
Collapse
|
37
|
Khan MA, Patel KB, Nooruddin M, Swanson G, Fogg L, Keshavarzian A, Brown M. Polyethylene Glycol-3350 (Miralax®)+1.9-L sports drink (Gatorade®)+2 tablets of bisacodyl results in inferior bowel preparation for colonoscopy compared with Polyethylene Glycol-Ascorbic Acid (MoviPrep®). TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:67-74. [PMID: 29391310 DOI: 10.5152/tjg.2018.17536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS Polyethylene glycol (PEG)-3350, approved by Food and Drug Administration (FDA) only for constipation, combined with 1.9 L of sports drink (SD) (GatoradeR) and bisacodyl (B) is commonly used in outpatient practice for bowel preparation due to cited patient satisfaction and tolerability of this specific regimen. We aim to compare PEG-3350 (MiralaxR) with PEG-AA-based (MoviPrepR) in terms of efficacy, patient satisfaction, and the effects of these two regimen on serum electrolytes. MATERIALS AND METHODS This study is a prospective, single-blinded, block randomized trial comparing single-dose PEG-3350+SD+B to split-dose 2-L PEG-AA in the outpatient endoscopy unit in patients undergoing colonoscopy. Basic metabolic profiles were checked on the day of randomization and on the day of procedure. Patients completed a survey on the day of procedure. Bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS) by two endoscopists and a nurse present during the procedure. RESULTS We randomized 150 patients (74 PEG-3350+SD+B and 76 PEG-AA). The PEG-AA group had significantly higher BBPS scores in the right colon by Endoscopist 1, Nurse, and Endoscopist 2 (p 0.005, <0.000, 0.001) and in the left and transverse colon by Nurse and Endoscopist 2 (p 0.004, 0.26, 0.000, 0.006). There was no statistically significant difference in patient satisfaction or change in serum electrolytes between the two groups. CONCLUSION Use of single-dose PEG-3350+SD+B results in inferior bowel preparation for colonoscopy compared with split-dose PEGAA and does not provide any advantage in regards to patient satisfaction. We therefore recommend discontinuing the use of PEG 3350 for bowel preparation.
Collapse
Affiliation(s)
- Maqsood Ahmed Khan
- Department of Gastroenterology and Hepatology, Aurora Health Care, West Allis Hospital, West Allis, WI, USA
| | - Kevin B Patel
- Department of Gastroenterology and Hepatology, Rush University Medical Center, Chicago, IL, USA
| | - Mohammed Nooruddin
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
| | - Garth Swanson
- Department of Gastroenterology and Hepatology, Rush University Medical Center, Chicago, IL, USA
| | - Louis Fogg
- Department of Gastroenterology and Hepatology, Rush University Medical Center, Chicago, IL, USA
| | - Ali Keshavarzian
- Department of Gastroenterology and Hepatology, Rush University Medical Center, Chicago, IL, USA
| | - Michael Brown
- Department of Gastroenterology and Hepatology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
38
|
Bowel preparation in CT colonography: Is diet restriction necessary? A randomised trial (DIETSAN). Eur Radiol 2017; 28:382-389. [PMID: 28812132 DOI: 10.1007/s00330-017-4997-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 05/05/2017] [Accepted: 07/17/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To investigate whether diet restriction affects quality of colon cleansing and patient tolerance during reduced bowel preparation for CT colonography (CTC). METHODS Asymptomatic and symptomatic patients were enrolled in this pragmatic, single-centre, randomised trial. All patients were randomly assigned (1:1 ratio, blocks of ten) to receive a reduced bowel preparation and faecal tagging with (Diet-Restriction-Group [DR]) or without (No-Diet-Restriction-Group [NDR]) dietary restriction. Five readers performed a blinded subjective image analysis, by means of 4-point Likert-scales from 0 (highest score) to 3 (worst score). Endpoints were the quality of large bowel cleansing and tolerance to the assigned bowel preparation regimen. The trial is registered at ClinicalTrial.gov (URomLSDBAL1). RESULTS Ninety-five patients were randomly allocated to treatments (48 in NDR-group, 47 in DR-group). Both groups resulted in optimal colon cleansing. The mean residual stool (0.22, 95%CI 0.00-0.44) and fluid burden (0.39, 95%CI 0.25-0.53) scores for patients in DR-group were similar to those in patients in NDR-group (0.25, 95%CI 0.03-0.47 [p = 0.82] and 0.49, 95%CI 0.30-0.67 [p = 0.38], respectively). Tolerance was significantly better in NDR-group. CONCLUSION A reduced bowel preparation in association with faecal tagging and without any dietary restriction demonstrated optimal colon cleansing effectiveness for CTC, providing better patient compliance compared with dietary restriction. KEY POINTS • Dietary restriction in reduced bowel preparation regimen can be avoided. • The quality of colon cleansing is not affected by dietary restriction. • The quality of faecal tagging is not affected by dietary restriction. • Avoidance of dietary restriction improves patients' tolerance for CTC.
Collapse
|
39
|
Tepeš B, Bracko M, Novak Mlakar D, Stefanovic M, Stabuc B, Frkovic Grazio S, Maucec Zakotnik J. Results of the FIT-based National Colorectal Cancer Screening Program in Slovenia. J Clin Gastroenterol 2017; 51:e52-e59. [PMID: 27552327 DOI: 10.1097/mcg.0000000000000662] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common malignancies in the western world. OBJECTIVE We aimed to assess the first round of fecal immunochemical test (FIT)-based National CRC screening program (NCSP). METHODS In the NCSP conducted in Slovenia, a FIT and colonoscopy for those tested positive was used. The NCSP central unit sent 536,709 invitations to Slovenian residents age 50 to 69 years old between 2009 and 2011. The adherence rate was 56.9% (303,343 participants). FIT was positive in 6.2% (15,310) of the participants (men, 7.8%; women, 5.0%; P<0.01). A total of 13,919 unsedated colonoscopies were performed with the cecal intubation rate of 97.8%. RESULTS The overall adenoma detection rate was 51.3% [95% confidence interval (CI), 50.5%-52.1%] of which 61.0% (95% CI, 59.9%-62.1%) was in men, and 39.1% (95% CI, 37.8%-40.3%) in women (P<0.01). The mean number of adenoma per positive colonoscopy was 1.94 (95% CI, 1.90-1.97). Adenoma, advanced adenoma, or cancer were found in 7732 (55.5%) colonoscopies. A total of 862 (6.2%) CRC cases were found. Only 161 (18.7%) carcinomas were situated in the right colon. A total of 597 (70.2%) patients with cancer were in the early clinical stages (N, negative; 194 22.8%) of all cancers were cured with only endoscopic resection. CONCLUSIONS In the NCSP, CRC was found in 6.2% of those participants attending colonoscopy, with 81.3% of carcinomas found in the left colon. A localized clinical stage was found in 70.2% participants. In 22.8% of CRC patients, cancer was cured with endoscopic resection only.
Collapse
Affiliation(s)
- Bojan Tepeš
- *AM DC Rogaška, Rogaška Slatina †University Clinical Center ‡National Institute for Public Health, Ljubljana §DC Bled, Bled, Slovenia
| | | | | | | | | | | | | |
Collapse
|
40
|
Multiple behavioral factors are associated with occurrence of large, flat colorectal polyps. Int J Colorectal Dis 2017; 32:575-582. [PMID: 27896421 DOI: 10.1007/s00384-016-2717-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The prevalence of advanced dysplasia and synchronous lesions is particularly high in patients with large, flat colorectal polyps. However, the impact of lifestyle on the development of such polyps is poorly investigated. Hence, this study aims to identify associations between behavioral factors and the occurrence of large, flat colorectal polyps. METHODS Behavioral factors were retrospectively analyzed in patients with large, flat polyps and control patients with at most one diminutive polyp. Information on lifestyle factors, comorbidities, and demographic parameters were determined by a structured, self-administered questionnaire. RESULTS Questionnaires of 350 patients with large, flat polyps and 489 control patients were included in the analysis. Most large, flat colorectal polyps contained adenoma with low-grade neoplasia and were located in the right colon. Multivariate analysis showed that advanced age (per 1-year increase-OR 1.09, CI 1.07-1.11, p < 0.0001), frequent cigarette smoking (OR 2.04, CI 1.25-3.32, p = 0.0041), daily consumption of red meat (OR 3.61, CI 1.00-12.96, p = 0.0492), and frequent bowel movements (OR 1.62, CI 1.13-2.33, p = 0.0093) were independent risk factors for occurrence of large, flat colorectal polyps. In contrast, frequent intake of cereals (OR 0.62, CI 0.44-0.88, p = 0.0074) was associated with a reduced risk. CONCLUSION Multiple behavioral factors modulate the risk for developing large, flat colorectal polyps. This knowledge can be used to improve prevention of colorectal cancer.
Collapse
|
41
|
Walter J, Francis G, Matro R, Kedika R, Grosso R, Keith SW, Kastenberg D. The impact of diet liberalization on bowel preparation for colonoscopy. Endosc Int Open 2017; 5:E253-E260. [PMID: 28382323 PMCID: PMC5375955 DOI: 10.1055/s-0043-101694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and study aims Dietary restrictions are integral to colonoscopy preparation and impact patient satisfaction. Utilizing split-dose, lower-volume polyethylene glycol 3350-electrolyte solution (PEG-ELS), this study compared colon preparation adequacy of a low-residue diet to clear liquids using a validated grading scale. Patients and methods This was a prospective, randomized, single-blinded, single-center non-inferiority study evaluating diet the day prior to outpatient colonoscopy. Subjects were randomized to a Low-Residue diet for breakfast and lunch, or Clears only. All subjects received split dose PEG-ELS. The primary endpoint was preparation adequacy using the Boston Bowel Preparation Scale (BBPS), with adequate defined as a score > 5. Secondary endpoints included mean BBPS scores for the entire colon and individual segments, satisfaction, adverse events, polyp and adenoma detection rates, and impact on sleep and daily activities. Results Final analysis included 140 subjects, 72 assigned to Clears and 68 to Low-Residue. The Low-Residue diet was non-inferior to Clears (risk difference = - 5.08 %, P = 0.04) after adjusting for age. Mean colon cleansing scores were not significantly different overall and for individual colonic segments. Satisfaction with the Low-Residue diet was significantly greater (P = 0.01). The adenoma detection rate was not statistically significantly different between study groups, but the number of adenomas detected was significantly greater with Clears (P = 0.01). Adverse events and impact on sleep and activities did not differ significantly between diet arms. Conclusions A low-residue diet for breakfast and lunch the day prior to colonoscopy was non-inferior to clear liquids alone for achieving adequate colon cleansing when using split dose PEG-ELS.
Collapse
Affiliation(s)
- James Walter
- Department of Gastroenterology, Cooper University, Mount Laurel, New Jersey, United States,Corresponding author James Walter, MD 501 Fellowship RoadSuite 101Mount Laurel, NJ, United States 08054+1-856-642-2133
| | - Gloria Francis
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Rebecca Matro
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Ramalinga Kedika
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Rachael Grosso
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Scott W. Keith
- Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - David Kastenberg
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| |
Collapse
|
42
|
Michopoulos S, Manios E, Kourkoutas H, Argyriou K, Leonidakis G, Zampeli E, Stamatelopoulos K, Dimopoulos AM. Predictors of colorectal cancer screening awareness among people working in a hospital environment. Ann Gastroenterol 2017; 30:315-321. [PMID: 28469362 PMCID: PMC5411382 DOI: 10.20524/aog.2017.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/09/2017] [Indexed: 12/22/2022] Open
Abstract
Background Compliance rates for colorectal cancer (CRC) screening are much lower than those desired. Appropriate information on CRC risks and screening methods is supposed to stimulate motivation for screening. We aimed to identify parameters associated with the decision for CRC screening and colonoscopy in a population expected to have high awareness of disease prevention. Methods In a single-center, cross-sectional study, we used an anonymous questionnaire (AQ) to record the demographics, habits and screening behavior for cancers and other common diseases of all employees older than 50 years in our hospital. Results Among 287 active employees, 83% (n=237) answered the AQ (age 55±4 years). Thirty percent (n=70) underwent colonoscopy while 17% (n=40) underwent CRC screening (39/40) colonoscopy). Comparatively, among women 97% had a Pap-smear, 92% a mammography, while among men 83% had been tested for serum prostate-specific antigen. Age, male sex, alcohol consumption and university education correlated positively with CRC screening (P<0.05 for all). After multivariate analysis, university education remained an independent determinant of CRC screening (OR 2.488, 95%CI 1.096-5.648; P=0.029). Among subjects who had not undergone colonoscopy in the past, ignorance of the need for CRC screening (OR 0.360, 95%CI 0.150-0.867; P=0.023) and indifference to undergo such a procedure (OR 0.188, 95%CI 0.066-0.537; P=0.002) were independent determinants for not planning a future screening colonoscopy. Conclusions Education was the most important factor in the decision to undergo CRC screening. Colonoscopy was the preferred screening method. Ignorance of and indifference to CRC risks were the major obstacles for a future screening colonoscopy.
Collapse
Affiliation(s)
- Spyridon Michopoulos
- Gastroenterology Unit, "Alexandra" Hospital (Spyridon Michopoulos, Helias Kourkoutas, Konstantinos Argyriou, Georgios Leonidakis, Evanthia Zampeli)
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Alexandra Hospital (Efstathios Manios, Kimon Stamatelopoulos, Athanasios-Meletios Dimopoulos), Athens, Greece
| | - Helias Kourkoutas
- Gastroenterology Unit, "Alexandra" Hospital (Spyridon Michopoulos, Helias Kourkoutas, Konstantinos Argyriou, Georgios Leonidakis, Evanthia Zampeli)
| | - Konstantinos Argyriou
- Gastroenterology Unit, "Alexandra" Hospital (Spyridon Michopoulos, Helias Kourkoutas, Konstantinos Argyriou, Georgios Leonidakis, Evanthia Zampeli)
| | - Georgios Leonidakis
- Gastroenterology Unit, "Alexandra" Hospital (Spyridon Michopoulos, Helias Kourkoutas, Konstantinos Argyriou, Georgios Leonidakis, Evanthia Zampeli)
| | - Evanthia Zampeli
- Gastroenterology Unit, "Alexandra" Hospital (Spyridon Michopoulos, Helias Kourkoutas, Konstantinos Argyriou, Georgios Leonidakis, Evanthia Zampeli)
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Alexandra Hospital (Efstathios Manios, Kimon Stamatelopoulos, Athanasios-Meletios Dimopoulos), Athens, Greece
| | - Athanasios-Meletios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Alexandra Hospital (Efstathios Manios, Kimon Stamatelopoulos, Athanasios-Meletios Dimopoulos), Athens, Greece
| |
Collapse
|
43
|
Salimzadeh H, Bishehsari F, Delavari A, Barzin G, Amani M, Majidi A, Sadjadi A, Malekzadeh R. Cancer risk awareness and screening uptake in individuals at higher risk for colon cancer: a cross-sectional study. BMJ Open 2016; 6:e013833. [PMID: 27998901 PMCID: PMC5223631 DOI: 10.1136/bmjopen-2016-013833] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We aimed to measure cancer knowledge and feasibility of a screening colonoscopy among a cohort of individuals at higher risk of colon cancer. METHODS This study was conducted as part of an ongoing screening cohort, in which first degree relatives (FDRs) of patients with colon cancer are invited to participate in a free of charge screening colonoscopy. We enrolled 1017 FDRs in the study between 2013 and 2014 measuring their data on demographics, cancer knowledge and colonoscopy uptake. A p value of <0.05 was considered statistically significant. RESULTS The relative's mean age was 48.7 years. Only about 28% of FDRs were aware of their increased risk for cancer, near 35.0% had ever heard about colonoscopy with 22% aware of the correct age to start screening. Comparing cancer knowledge of FDRs at high risk versus those at moderate risk, we recorded non-significant differences (p>0.05). Almost two-thirds of FDRs expressed willingness to undergo a colonoscopy and 49.2% completed the procedure, of which 12.8% had advanced neoplasm. CONCLUSIONS Our data indicated that remarkable numbers of FDRs were not still informed of their cancer risk or never received a physician recommendation for screening. The desirable uptake at first invitation, which would be higher over successive invitations, supports the feasibility of a family-based recruitment approach for early screening. This has promising implications to introduce targeted screening colonoscopy into the healthcare system in Iran and other developing nations.
Collapse
Affiliation(s)
- Hamideh Salimzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Faraz Bishehsari
- Division of Gastroenterology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Alireza Delavari
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Gilda Barzin
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Mohammad Amani
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Azam Majidi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Alireza Sadjadi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| |
Collapse
|
44
|
van Lieshout I, Munsterman ID, Eskes AM, Maaskant JM, van der Hulst R. Systematic review and meta-analysis: Sodium picosulphate with magnesium citrate as bowel preparation for colonoscopy. United European Gastroenterol J 2016; 5:917-943. [PMID: 29163958 DOI: 10.1177/2050640616684696] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/23/2016] [Indexed: 12/12/2022] Open
Abstract
Background An effective and tolerable bowel preparation is important to secure quality of colonoscopies. It remains unclear if sodium picosulphate with magnesium citrate (SPMC), which is considered a tolerable bowel preparation agent, is also an effective alternative for polyethylene glycol (PEG) and sodium phosphate (NaP). Aim The aim of this article is to compare effectiveness of SPMC to PEG and NaP through assessment of quality of bowel cleansing measured by validated tools. Methods We searched electronic databases up to January 2015. Only randomised controlled trials (RCTs) were included. Two authors independently performed selection of studies, risk of bias assessment and data extraction. Results Thirteen RCTs were included, with overall good quality, but large heterogeneity. SPMC had slightly better quality of bowel cleansing than PEG (pooled RR 1.06; 95% CI 1.02 to 1.11). In most trials SPMC was significantly better tolerated than PEG. There were no significant differences in effectiveness or tolerability between SPMC and NaP. Side effects were similar between agents, except for dizziness (pooled RR 1.71; 95% CI 1.32 to 2.21 in favour of PEG vs. SPMC) and vomiting (pooled RR 0.35; 95% CI 0.13 to 0.95 in favour of single-dose SPMC vs. split-dose). Conclusions SPMC is equally effective to NaP and little superior to PEG in terms of bowel cleansing. SPMC preparations were better tolerated than PEG preparations. SPMC may be considered as standard bowel preparation for colonoscopy.
Collapse
Affiliation(s)
- Ilvy van Lieshout
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Isabelle D Munsterman
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Anne M Eskes
- Research Centre Spaarne Gasthuis Academy, Spaarne Gasthuis, Haarlem, The Netherlands.,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jolanda M Maaskant
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Academic Medical Center and University of Amsterdam, The Netherlands
| | - René van der Hulst
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands
| |
Collapse
|
45
|
Ogino N, Aridome G, Oshima J, Shibata M, Watanabe T, Kume K, Yoshikawa I, Harada M. Serum Albumin Concentrations Predict hypovolaemia Caused by Polyethylene Glycol Plus Ascorbic Acid Prior to Colonoscopy in Elderly Patients. Drugs Aging 2016; 33:355-63. [PMID: 26895453 DOI: 10.1007/s40266-016-0355-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies have confirmed the safety of polyethylene glycol plus ascorbic acid for healthy middle-aged adults but not for the elderly. The osmotic pressure of polyethylene glycol plus ascorbic acid is approximately twice that of plasma osmolality and may cause dehydration. OBJECTIVE In this study, we determined whether dehydration was induced in elderly patients by polyethylene glycol plus ascorbic acid, and we analysed the data obtained in order to identify predictors of dehydration. METHODS This was a prospective, uncontrolled, before-and-after intervention study. All patients older than 65 years who underwent colonoscopies at the Moji Medical Center were administered polyethylene glycol plus ascorbic acid prior to colonoscopy. Clinical variables before and after bowel preparation were measured and analysed statistically. A multiple linear regression analysis was performed to identify predictors of dehydration due to this procedure. RESULTS Eighty-three patients were assessed for eligibility, and 74 clinical variables were ultimately analysed. A significant increase in the red blood cell count (4.10 versus 4.25 × 10(6)/mm(3)), haemoglobin level (12.4 versus 13.0 g/dL) and haematocrit (38.1% versus 39.4%) suggested the presence of hypovolaemia after the procedure (P < 0.001). The serum concentration of albumin before bowel preparation was identified as the only significant predictor of hypovolaemia (β = 0.47, P = 0.0001, adjusted R (2) = 0.22). CONCLUSION The serum concentration of albumin before bowel preparation predicted hypovolaemia caused by polyethylene glycol plus ascorbic acid in elderly patients. Therefore, care is needed in order to prevent hypovolaemia, especially in elderly patients with hypoalbuminaemia. TRIAL REGISTRATION No. 000015724 (University Hospital Medical Information Network Center).
Collapse
Affiliation(s)
- Noriyoshi Ogino
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan. .,Department of Internal Medicine, Moji Medical Center, Kitakyushu, Japan.
| | - Gentaro Aridome
- Department of Internal Medicine, Moji Medical Center, Kitakyushu, Japan.,Department of Gastroenterology, Wakamatsu Hospital of University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Junji Oshima
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.,Department of Internal Medicine, Moji Medical Center, Kitakyushu, Japan
| | - Michihiko Shibata
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Tatsuyuki Watanabe
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Keiichiro Kume
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Ichiro Yoshikawa
- Department of Endoscopy, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Masaru Harada
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| |
Collapse
|
46
|
Health screening behaviors among adults with hereditary hemorrhagic telangiectasia in North America. Genet Med 2016; 19:659-666. [PMID: 27735923 PMCID: PMC5391304 DOI: 10.1038/gim.2016.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/30/2016] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study aimed to identify factors that influence screening behaviors of adults with hereditary hemorrhagic telangiectasia (HHT). METHODS Participants with a self-reported diagnosis of HHT were recruited from the HHT Foundation International, Inc.; the "HHT Awareness" Facebook group; and six HHT clinics. A cross-sectional mixed methods survey was administered to investigate the relationships among the Health Belief model constructs, the domains of illness representations, and HHT-specific screening behaviors consistent with recommended guidelines. RESULTS A total of 320 participants reported rates of cerebral arteriovenous malformation (AVM) screenings, pulmonary AVM screenings, and HHT annual checkups that were 82.0, 67.1, and 56.5%, respectively. Logistical regression analysis showed that perceived barriers (β = -0.114, P < 0.001), perceived susceptibility (β = 0.117, P < 0.05), treatment control (β = 0.078, P < 0.05), and emotional representations (β = 0.067, P < 0.05) were significant predictors of HHT screening. Open-ended responses revealed perceived barriers to screening, including a lack of health-care providers (HCPs) familiar with and/or knowledgeable about HHT. CONCLUSION Our results reveal suboptimal screening rates among adults with HHT and identify several factors influencing these behaviors. We suggest that there is a need for increased provider education regarding HHT as well as approaches that providers can use to improve screening adherence.Genet Med advance online publication 13 October 2016.
Collapse
|
47
|
Horton N, Garber A, Hasson H, Lopez R, Burke CA. Impact of Single- vs. Split-Dose Low-Volume Bowel Preparations on Bowel Movement Kinetics, Patient Inconvenience, and Polyp Detection: A Prospective Trial. Am J Gastroenterol 2016; 111:1330-7. [PMID: 27377521 DOI: 10.1038/ajg.2016.273] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/01/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES There are little data on bowel movement (BM) kinetics induced by bowel preparation. Whether single-dose (SID) or split-dose (SPD) regimens differ in terms of patient convenience is unclear. We compared BM kinetics, sleep and travel disruptions, and polyp detection rates in patients undergoing colonoscopy assigned to SID vs. SPDs. METHODS Patients were randomly assigned to 2-L SID or SPD (SPD1 and SPD2) bowel preparations. Surveys were completed querying the onset, duration, cessation, and intensity of BMs, along with sleep and travel disruption en route to the endoscopy center. Colon cleansing quality and polyp histology were recorded. RESULTS A total of 341 patients were enrolled, 51% in SPD and 49% in SID. Over half of patients had their first BM within 60 min of starting the preparation. After dosing, 92% of SID and 66% of SPD1 patients achieved clear effluent (P<0.001), whereas it was reported in 97% of SPD2 patients (P=0.028 vs. SID). Total duration (P=0.041) and intensity (P<0.001) of BMs were greater in SID. More patients in SID woke up for BMs (65.9 vs. 48.8%, P<0.003). No differences in the need to stop driving en route to colonoscopy were noted. Bowel prep quality was better in SPD (P<0.001). Although no difference in the adenoma detection rate was noted, the sessile-serrated polyp detection rate was greater in SPD than in SID (9.9 vs. 2.4%, P=0.004). CONCLUSIONS Our data demonstrate that SPD bowel preparation results in decreased intensity and duration of BMs, less patient inconvenience, improved bowel preparation, and increased sessile-serrated polyp detection rates.
Collapse
Affiliation(s)
- Nicholas Horton
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ari Garber
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Henrietta Hasson
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rocio Lopez
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carol A Burke
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
48
|
Utano K, Nagata K, Honda T, Mitsushima T, Yasuda T, Kato T, Horita S, Asano M, Oda N, Majima K, Kawamura Y, Hirayama M, Watanabe N, Kanazawa H, Lefor AK, Sugimoto H. Diagnostic Performance and Patient Acceptance of Reduced-Laxative CT Colonography for the Detection of Polypoid and Non-Polypoid Neoplasms: A Multicenter Prospective Trial. Radiology 2016; 282:399-407. [PMID: 27580426 DOI: 10.1148/radiol.2016160320] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the diagnostic accuracy and patient acceptance of reduced-laxative computed tomographic (CT) colonography without computer-aided detection (CAD) for the detection of colorectal polypoid and non-polypoid neoplasms in a population with a positive recent fecal immunochemical test (FIT). Materials and Methods Institutional review board approval and written informed consent were obtained. This multicenter prospective trial enrolled patients who had positive FIT results. Reduced-laxative CT colonography and colonoscopy were performed on the same day. Patients received 380 mL polyethylene glycol solution, 20 mL iodinated oral contrast agent, and two doses of 20 mg mosapride the day before CT colonography. The main outcome measures were the accuracy of CT colonography for the detection of neoplasms 6 mm or larger in per-patient and per-lesion analyses and a survey of patient perceptions regarding the preparation and examination. The Clopper-Pearson method was used for assessing the 95% confidence intervals of per-patient and per-lesion accuracy. Survey scores were analyzed by using the Wilcoxon and χ2 tests. Results Three hundred four patients underwent both CT colonography and colonoscopy. Per-patient sensitivity, specificity, positive predictive value, and negative predictive value of CT colonography for detecting neoplasms 10 mm or larger were 0.91 (40 of 44), 0.99 (255 of 258), 0.93 (40 of 43), and 0.98 (255 of 259), respectively; these values for neoplasms 6 mm or larger were 0.90 (71 of 79), 0.93 (207 of 223), 0.82 (71 of 87), and 0.96 (207 of 215), respectively. Per-lesion sensitivities for detection of polypoid and non-polypoid neoplasms 10 mm or larger were 0.95 (40 of 42) and 0.67 (six of nine), respectively; those for neoplasms 6 mm or larger were 0.90 (104 of 115) and 0.38 (eight of 21), respectively (P < .05 for both). Patient acceptance of preparation and examination with CT colonography was significantly higher than that with colonoscopy, and 62% (176 of 282) of patients would choose CT colonography as the first examination if they have a positive FIT result in the future. Conclusion Reduced-laxative CT colonography without CAD is accurate in the detection of polypoid neoplasms 6 mm or larger but is less accurate in the detection of non-polypoid neoplasms. Reduced-laxative CT colonography has high patient acceptance and is an efficient triage examination for patients with a positive FIT. © RSNA, 2016 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Kenichi Utano
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Koichi Nagata
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Tetsuro Honda
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Toru Mitsushima
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Takaaki Yasuda
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Takashi Kato
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Shoichi Horita
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Michio Asano
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Noritaka Oda
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Kenichiro Majima
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Yasutaka Kawamura
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Michiaki Hirayama
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Naoki Watanabe
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Hidenori Kanazawa
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Alan Kawarai Lefor
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| | - Hideharu Sugimoto
- From the Departments of Radiology (K.U., K.N., H.K., H.S.) and Surgery (A.K.L.), Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (K.N.); Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan (T.H.); Department of Gastroenterology, Kameda Medical Center Makuhari, Chiba, Japan (T.M.); Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan (T.Y.); Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan (T.K., S.H.); Endoscopic Center, Matsuda Hospital, Hamamatsu, Shizuoka, Japan (M.A., N.O.); Departments of Health Management (K.M.) and Radiology (Y.K.), Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Gastroenterology, Tonan Hospital, Sapporo, Japan (M.H.); and Radiology Section, Otaru Kyokai Hospital, Otaru, Japan (N.W.)
| |
Collapse
|
49
|
Greuter MJE, Berkhof J, Fijneman RJA, Demirel E, Lew JB, Meijer GA, Stoker J, Coupé VMH. The potential of imaging techniques as a screening tool for colorectal cancer: a cost-effectiveness analysis. Br J Radiol 2016; 89:20150910. [PMID: 27194458 DOI: 10.1259/bjr.20150910] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Imaging may be promising for colorectal cancer (CRC) screening, since it has test characteristics comparable with colonoscopy but is less invasive. We aimed to assess the potential of CT colonography (CTC) and MR colonography (MRC) in terms of (cost-effectiveness) using the Adenoma and Serrated pathway to Colorectal CAncer model. METHODS We compared several CTC and MRC strategies with 5- or 10-yearly screening intervals with no screening, 10-yearly colonoscopy screening and biennial faecal immunochemical test (FIT) screening. We assumed trial-based participation rates in the base-case analyses and varied the rates in sensitivity analyses. Incremental lifetime costs and health effects were estimated from a healthcare perspective. RESULTS The health gain of CTC and MRC was similar and ranged from 0.031 to 0.048 life-year gained compared with no screening, for 2-5 screening rounds. Lifetime costs per person for MRC strategies were €60-110 higher than those for CTC strategies with an equal number of screening rounds. All imaging-based strategies were cost-effective compared with no screening. FIT screening was the dominant screening strategy, leading to most LYG and highest cost-savings. Compared with three rounds of colonoscopy screening, CTC with five rounds was found to be cost-effective in an incremental analysis of imaging strategies. Assumptions on screening participation have a major influence on the ordering of strategies in terms of costs and effects. CONCLUSION CTC and MRC have potential for CRC screening, compared with no screening and compared with three rounds of 10-yearly colonoscopy screening. When taking FIT screening as the reference, imaging is not cost-effective. Participation is an important driver of effectiveness and cost estimates. ADVANCES IN KNOWLEDGE This is the first study to assess the cost-effectiveness of MRC screening for CRC.
Collapse
Affiliation(s)
- Marjolein J E Greuter
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Johannes Berkhof
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Remond J A Fijneman
- 2 Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Erhan Demirel
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Jie-Bin Lew
- 3 Cancer Research Division, Cancer Council NSW, NSW, Australia
| | - Gerrit A Meijer
- 2 Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jaap Stoker
- 4 Department of Radiology, Academic Medical Center, Amsterdam, Netherlands
| | - Veerle M H Coupé
- 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| |
Collapse
|
50
|
Triantafyllou K, Gkolfakis P, Triantafyllou M, Ndini X, Melissaratou A, Moustafa GA, Xanthopoulou E, Tziatzios G, Vlachonikolou G, Papadopoulos V, Pantelakis E, Malli C, Dimitriadis GD. Long-term patient satisfaction of gastrointestinal endoscopic procedures. Ann Gastroenterol 2016; 29:188-95. [PMID: 27065732 PMCID: PMC4805739 DOI: 10.20524/aog.2016.0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background We prospectively assessed patient satisfaction in a Greek Academic endoscopy facility. Methods Consecutive outpatients filled a satisfaction questionnaire right after their endoscopy (D1), 3 days (D3) and 3 months (M3) later. Overall patient satisfaction was measured by their willingness to repeat endoscopy in our facility and to further recommend it. Participant satisfaction regarding pre-procedural, procedural and post-procedural issues was measured using a five-step Likert scale in 19 items with 4 and 5 scores indicating favorable responses. Pareto analysis was used to determine service issues requiring improvement. Late adverse events were recorded at D3 and M3 assessments. Results Over six months, 501 patients participated (89.4% and 87.8% response rate at D3 and M3 assessments, respectively). More than 97% of the participants would repeat the procedure in our facility and would recommend our endoscopy service, at all three assessments. Pareto analysis identified waiting time until the appointment and on the day of the examination, discomfort during and after the endoscopy, time to obtain the pathology report and overall management of the patient problems as the issues requiring improvement. No predictor of high satisfaction score has been identified. No serious late adverse events were reported. Conclusion Despite the overall high levels of patient satisfaction, management of patient discomfort and organizational issues need improvement.
Collapse
Affiliation(s)
- Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Maria Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Xhoela Ndini
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Anastasia Melissaratou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Giannis-Aimant Moustafa
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Eleni Xanthopoulou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Georgia Vlachonikolou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Vasilios Papadopoulos
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Evdoxos Pantelakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Chrysoula Malli
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - George D Dimitriadis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| |
Collapse
|