1
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Kang HS, Na SY, Yoon JY, Jung Y, Seo GS, Cha JM. Efficacy, tolerability, and safety of oral sulfate tablet versus 2 L-polyethylene glycol/ascorbate for bowel preparation in older patients: prospective, multicenter, investigator single-blinded, randomized study. J Gastroenterol 2024; 59:402-410. [PMID: 38492010 DOI: 10.1007/s00535-024-02089-9] [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: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND We compared the efficacy, tolerability, and safety of oral sulfate tablets (OST, which contains simethicone) and 2 L-polyethylene glycol/ascorbate (2 L-PEG/Asc) with a split-dosing regimen in older individuals aged ≥ 70 years who underwent scheduled colonoscopy. METHODS This prospective, randomized, investigator-blinded, multicenter study was conducted between June 2022 and October 2023. Participants aged ≥ 70 years were randomized at a ratio of 1:1 to the OST or 2 L-PEG/Asc groups. RESULTS In total, 254 patients were evaluated using a modified full analysis set. Successful overall bowel preparation was excellent and similar between the OST and 2 L-PEG/Asc groups for the Boston Bowel Preparation Scale (BBPS) (96.5% vs. 96.6%) and Harefield Cleansing Scale (HCS) (96.5% vs. 97.4%). The overall high-quality preparation rate was higher in the OST group than in the 2 L-PEG/Asc group (BBPS: 55.7% vs. 28.4%, P < 0.001; HCS: 66.1% vs. 38.8%, P < 0.001). The overall adenoma detection rate (54.8% vs. 35.3, P = 0.003) was superior in the OST group compared to the 2 L-PEG/Asc group. Tolerability scores, including overall satisfaction, were generally higher in the OST group than in the 2 L-PEG/Asc group. The incidence of major solicited adverse events was comparable between the two groups (55.7% vs. 68.1, P = 0.051), and there were no clinically significant changes in the serum laboratory profiles on the day of or 7 days after colonoscopy. CONCLUSIONS OST is an effective and safe low-volume agent for colonoscopy, with better tolerance than 2 L-PEG/Asc, in older individuals aged ≥ 70 years.
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Affiliation(s)
- Ho Suk Kang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Soo-Young Na
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Geom Seog Seo
- Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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2
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Park JH, Hong SW, Hwang SW, Park SH, Yang DH, Ye BD, Myung SJ, Yang SK, Byeon JS. Efficacy and safety of oral sodium sulfate tablet compared with 1-L polyethylene glycol plus ascorbate: a prospective, randomized, endoscopist-blinded trial. J Gastroenterol Hepatol 2023; 38:2090-2096. [PMID: 37655723 DOI: 10.1111/jgh.16343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND AIM Low-volume bowel preparation solutions, including 1-L polyethylene glycol plus ascorbate (PEG-A), have been developed to improve tolerability. The oral sodium sulfate tablet (OST) is a new agent with simethicone as a preloaded component. We investigated the efficacy, safety, and tolerability of OST compared to 1-L PEG-A. METHODS A single-center, prospective, controlled study was performed with randomization into the OST (group A) and 1-L PEG-A (group B) groups. Bowel preparation efficacy was assessed on the Boston Bowel Preparation Scale (BBPS) and Bubble Scale. Safety and tolerability were evaluated using a questionnaire and laboratory examination. RESULTS Final analysis was performed on 171 patients (group A: 87, group B: 84). The proportion of bowel preparation success (BBPS ≥ 2 for each colonic segment) in group A was not inferior compared to group B (95.4% vs 96.4%, P = 0.736, 1-sided 97.5% lower confidence limit -7.0%). The adenoma detection rate was not different (59.6% vs 41.9%; P = 0.087). The bubble scale was better in group A (0.2 ± 0.9 vs 1.9 ± 1.7, P < 0.001). All adverse events were mild in both groups. Nausea was less frequent in group A (14.9% vs 38.1%, P = 0.001). Overall satisfaction was better in group A (8.1 ± 2.1 vs 6.4 ± 2.8, P < 0.001). No clinically significant laboratory abnormality developed in both groups. These findings were similarly shown in old patients ≥65 years. CONCLUSIONS Both OST and 1-L PEG-A were efficacious, safe, and tolerable for bowel preparation of colonoscopy. The OST showed fewer bubbles and slightly better tolerability.
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Affiliation(s)
- Jin Hwa Park
- Department of Gastroenterology, University of Hanyang College of Medicine, Seoul, South Korea
| | - Seung Wook Hong
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Byong Duk Ye
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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3
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Li JW, Wu CCH, Lee JWJ, Liang R, Soon GST, Wang LM, Koh XH, Koh CJ, Chew WD, Lin KW, Thian MY, Matthew R, Kim G, Khor CJL, Fock KM, Ang TL, So JBY. Real-World Validation of a Computer-Aided Diagnosis System for Prediction of Polyp Histology in Colonoscopy: A Prospective Multicenter Study. Am J Gastroenterol 2023; 118:1353-1364. [PMID: 37040553 DOI: 10.14309/ajg.0000000000002282] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Computer-aided diagnosis (CADx) of polyp histology could support endoscopists in clinical decision-making. However, this has not been validated in a real-world setting. METHODS We performed a prospective, multicenter study comparing CADx and endoscopist predictions of polyp histology in real-time colonoscopy. Optical diagnosis based on visual inspection of polyps was made by experienced endoscopists. After this, the automated output from the CADx support tool was recorded. All imaged polyps were resected for histological assessment. Primary outcome was difference in diagnostic performance between CADx and endoscopist prediction of polyp histology. Subgroup analysis was performed for polyp size, bowel preparation, difficulty of location of the polyps, and endoscopist experience. RESULTS A total of 661 eligible polyps were resected in 320 patients aged ≥40 years between March 2021 and July 2022. CADx had an overall accuracy of 71.6% (95% confidence interval [CI] 68.0-75.0), compared with 75.2% (95% CI 71.7-78.4) for endoscopists ( P = 0.023). The sensitivity of CADx for neoplastic polyps was 61.8% (95% CI 56.9-66.5), compared with 70.3% (95% CI 65.7-74.7) for endoscopists ( P < 0.001). The interobserver agreement between CADx and endoscopist predictions of polyp histology was moderate (83.1% agreement, κ 0.661). When there was concordance between CADx and endoscopist predictions, the accuracy increased to 78.1%. DISCUSSION The overall diagnostic accuracy and sensitivity for neoplastic polyps was higher in experienced endoscopists compared with CADx predictions, with moderate interobserver agreement. Concordance in predictions increased this diagnostic accuracy. Further research is required to improve the performance of CADx and to establish its role in clinical practice.
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Affiliation(s)
- James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
| | - Clement Chun Ho Wu
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore Health Services, Singapore
| | - Jonathan Wei Jie Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Raymond Liang
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Gwyneth Shook Ting Soon
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Lai Mun Wang
- Department of Laboratory Medicine, Changi General Hospital, Singapore Health Services, Singapore
| | - Xuan Han Koh
- Department of Health Sciences Research, Changi General Hospital, Singapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Wei Da Chew
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Kenneth Weicong Lin
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
| | - Mann Yie Thian
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Ronnie Matthew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore Health Services, Singapore
| | - Guowei Kim
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- University Surgical Cluster, National University Hospital, Singapore
| | - Christopher Jen Lock Khor
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore Health Services, Singapore
| | - Kwong Ming Fock
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
| | - Jimmy Bok Yan So
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- University Surgical Cluster, National University Hospital, Singapore
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4
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Keating E, Leyden J, O'Connor DB, Lahiff C. Unlocking quality in endoscopic mucosal resection. World J Gastrointest Endosc 2023; 15:338-353. [PMID: 37274555 PMCID: PMC10236981 DOI: 10.4253/wjge.v15.i5.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
A review of the development of the key performance metrics of endoscopic mucosal resection (EMR), learning from the experience of the establishment of widespread colonoscopy quality measurements. Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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5
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Cao RR, Wang L, Gao C, Pan JH, Yoshida EM, Li HY, Qi XS. Effect of oral simethicone on the quality of colonoscopy: A systematic review and meta-analysis of randomized controlled trials. J Dig Dis 2022; 23:134-148. [PMID: 35075814 DOI: 10.1111/1751-2980.13084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE In this systematic review and meta-analysis, we aimed to investigate the effect of oral simethicone (SIM), an antifoaming agent, on the quality of colonoscopy in terms of bowel preparation quality, adenoma or polyp detection rate (ADR/PDR) and cecal intubation rate (CIR). METHODS All randomized controlled trials (RCTs) on the use of SIM during bowel preparation for colonoscopy published up to 17 March 2021 were identified from the PubMed, EMBASE and Cochrane Library databases. Bowel preparation quality, ADR/PDR/CIR, cecal intubation time (CIT), withdrawal time (WT), patients' tolerability, acceptability and volume of foam and bubbles were compared between the SIM and non-SIM groups. RESULTS Thirty-eight RCTs with 10 505 patients were included. Oral SIM significantly increased the rate of total Boston bowel preparation scale (BBPS) score ≥6 (risk ratio [RR] 1.13, P < 0.0001), acceptability (RR 1.15, P = 0.01) and the rate of no or minimal foam and bubbles (RR 1.28, P < 0.00001) and decreased abdominal distension (RR 0.64, P < 0.0001). However, it had no significant impact on overall ADR, overall PDR, CIR, CIT or WT. The rate of total BBPS score ≥6 remained significantly higher in the SIM group when a single-dose laxative regimen or a SIM dosage of ≥320 mg was employed; and ADR, PDR and CIR were significantly increased in the SIM group among colonoscopy clinicians who achieved an ADR <31%, PDR <45% and CIR <96%, respectively. CONCLUSIONS Oral SIM can improve bowel preparation quality, especially in patients receiving a SIM dosage of ≥320 mg or a single-dose laxative regimen. SIM may be preferred by junior colonoscopy physicians/trainees with a lower ADR/PDR or CIR.
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Affiliation(s)
- Rong Rong Cao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China.,Postgraduate College, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Le Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China.,China Medical University, Shenyang, Liaoning Province, China
| | - Cong Gao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Jia Hui Pan
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Eric M Yoshida
- Division of Gastroenterology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Hong Yu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Xing Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
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6
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Taveira F, Hassan C, Kaminski MF, Ponchon T, Benamouzig R, Bugajski M, de Castelbajac F, Cesaro P, Chergui H, Goran L, Minelli Grazioli L, Janičko M, Januszewicz W, Lamonaca L, Lenz J, Negreanu L, Repici A, Spada C, Spadaccini M, State M, Szlak J, Veseliny E, Dinis-Ribeiro M, Areia M. The Colon Endoscopic Bubble Scale (CEBuS): a two-phase evaluation study. Endoscopy 2022; 54:45-51. [PMID: 33285583 DOI: 10.1055/a-1331-4325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND To date, no scale has been validated to assess bubbles associated with bowel preparation. This study aimed to develop and assess the reliability of a novel scale - the Colon Endoscopic Bubble Scale (CEBuS). METHODS This was a multicenter, prospective, observational study with two online evaluation phases of 45 randomly distributed still colonoscopy images (15 per scale grade). Observers assessed images twice, 2 weeks apart, using CEBuS (CEBuS-0 - no or minimal bubbles, covering < 5 % of the surface; CEBuS-1 - bubbles covering 5 %-50 %; CEBuS-2 - bubbles covering > 50 %) and reporting the clinical action (do nothing; wash with water; wash with simethicone). RESULTS CEBuS provided high levels of agreement both in evaluation Phase 1 (4 experts) and Phase 2 (6 experts and 13 non-experts), with almost perfect intraobserver reliability: kappa 0.82 (95 % confidence interval 0.75-0.88) and 0.86 (0.85-0.88); interobserver agreement - intraclass correlation coefficient (ICC) 0.83 (0.73-0.89) and 0.90 (0.86-0.94). Previous endoscopic experience had no influence on agreement among experts vs. non-experts: kappa 0.86 (0.80-0.91) vs. 0.87 (0.84-0.89) and ICC 0.91 (0.87-0.94) vs. 0.90 (0.86-0.94), respectively. Interobserver agreement on clinical action was ICC 0.63 (0.43-0.78) in Phase 1 and 0.77 (0.68-0.84) in Phase 2. Absolute agreement on clinical action per scale grade was 85 % (82-88) for CEBuS-0, 21 % (16-26) for CEBuS-1, and 74 % (70-78) for CEBuS-2. CONCLUSION CEBuS proved to be a reliable instrument to standardize the evaluation of colonic bubbles during colonoscopy. Assessment in daily practice is warranted.
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Affiliation(s)
- Filipe Taveira
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Cesare Hassan
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michal F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.,Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Thierry Ponchon
- Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Robert Benamouzig
- Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France
| | - Marek Bugajski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | | | - Paola Cesaro
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Hasnae Chergui
- Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France
| | - Loredana Goran
- Department of Gastroenterology, University Hospital, 'Carol Davila' University Bucharest, Romania
| | | | - Martin Janičko
- 2nd Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovakia
| | - Wladyslaw Januszewicz
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Laura Lamonaca
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Lombardia, Italy
| | - Jamila Lenz
- Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Lucian Negreanu
- Department of Gastroenterology, University Hospital, 'Carol Davila' University Bucharest, Romania
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Lombardia, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Spadaccini
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Lombardia, Italy
| | - Monica State
- Department of Gastroenterology, University Hospital, 'Carol Davila' University Bucharest, Romania
| | - Jakub Szlak
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Eduard Veseliny
- 2nd Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovakia
| | - Mário Dinis-Ribeiro
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal.,Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
| | - Miguel Areia
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
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7
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Li X, Diao L, Zhang W, Fan R, Shi C, Cui Y, Hong J. Low-volume regimen without additional liquids or adjunctive agents versus standard bowel preparation in non-constipated patients: a propensity score matching analysis. Scand J Gastroenterol 2022; 57:105-111. [PMID: 34521311 DOI: 10.1080/00365521.2021.1977842] [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] [Indexed: 02/04/2023]
Abstract
AIMS Split-dose, 4-L polyethylene glycol (PEG, HSD) is currently the first-line choice for unselected or difficult colon preparations. Almost all low-volume bowel preparations (BPs) include a large volume of additional liquid and adjunctive agents to improve cleansing efficiency. However, neither HSD nor additional liquids or adjunctive agents of low-volume regimens may be necessary for low-risk patients. The aim of this study was to compare the cleansing efficiency between split-dose, low-volume (2-L) PEG without additional liquids or adjunctive agents (LSD) and HSD in non-constipated patients. METHODS A retrospective study was performed from January 2013 to December 2015. Consecutive non-constipated patients who received LSD or HSD BPs were enrolled into LSD and HSD groups. Propensity score matching (PSM) was used to reduce selection bias and potential confounders. The primary outcome was bowel cleansing quality, as evaluated by the Boston Bowel Preparation Scale (BBPS). The adenoma detection rate (ADR), the most important secondary outcome, was also recorded. Follow-up was conducted in 2016. RESULTS After excluding those participants who meet exclusion criteria or lost follow-up, 1656 non-constipated patients underwent LSD (n = 999) or HSD (n = 657) BP. Most patients had a BBPS score ≥6 (LSD vs. HSD, 93.6 vs. 92.9%, p = .166). The segmental BBPS scores were ≥2 in 92 and 91.9% in the LSD and HSD groups, respectively. The overall ADR was 16.7% in the LSD group and 17.5% in the HSD group (p = .334). CONCLUSION For non-constipated patients, LSD is not inferior to HSD in cleansing efficiency, while more willing to repeat the same BP.
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Affiliation(s)
- Xiang Li
- Department of Gastroenterology, Zhengzhou Tumor Hospital Affiliated to Henan University, Zhenzhou, China
| | - Lei Diao
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Weiping Zhang
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Renyu Fan
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chen Shi
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yufang Cui
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianglong Hong
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, China
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8
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Di Leo M, Iannone A, Arena M, Losurdo G, Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A. Novel frontiers of agents for bowel cleansing for colonoscopy. World J Gastroenterol 2021; 27:7748-7770. [PMID: 34963739 PMCID: PMC8661374 DOI: 10.3748/wjg.v27.i45.7748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’ acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’ tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.
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Affiliation(s)
- Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Monica Arena
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Pierluigi Consolo
- Unit of Digestive Endoscopy, University of Messina, Hospital "G. Martino", Messina 98121, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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9
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Zhu XJ, Yang L. Progress in understanding of factors related to colonoscopic adenoma detection rate. Shijie Huaren Xiaohua Zazhi 2021; 29:1304-1310. [DOI: 10.11569/wcjd.v29.i22.1304] [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] [Indexed: 02/06/2023] Open
Abstract
Adenoma detection rate (ADR) is the proportion of average-risk patients undergoing screening colonoscopy in whom an adenoma is found, and it is an important quality indicator of colonoscopy. ADR is closely related to the risk of interval colorectal cancer. A deeply study of ADR is essential for endoscopists. In this paper, we review the progress in the understanding of factors related to ADR before, during, and after colonoscopy, as well as several issues worthy of attention.
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Affiliation(s)
- Xiao-Jia Zhu
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
| | - Li Yang
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
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Optimal Timing of Simethicone Supplement for Bowel Preparation: A Prospective Randomized Controlled Trial. Can J Gastroenterol Hepatol 2021; 2021:4032285. [PMID: 34746040 PMCID: PMC8566047 DOI: 10.1155/2021/4032285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/23/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND AIMS Simethicone (SIM), as an antifoaming agent, has been shown to improve bowel preparation during colonoscopy. However, the optimal timing of SIM addition remained undetermined. We aimed to investigate the optimal timing of SIM addition to polyethylene glycol (PEG) to improve bowel preparation. METHODS Eligible patients were randomly assigned to two groups: the SIM evening group (SIM addition to PEG in the evening of the day prior to colonoscopy) and the SIM morning group (SIM addition to PEG in the morning of colonoscopy). The primary outcome was Bubble Scale (BS). The secondary outcomes were Boston Bowel Preparation Scale (BBPS) and adenoma detection rate (ADR). RESULTS A total of 419 patients were enrolled in this study. The baseline characteristics of the patients were similar in both groups. No significant differences were observed in terms of BS (8.76 ± 0.90 vs. 8.65 ± 1.16, P = 0.81), ADR (34.1% vs. 30.8%, P = 0.47), Boston Bowel Preparation Scale (BBPS) (8.59 ± 0.94 vs. 8.45 ± 1.00, P = 0.15), and withdrawal time (8.22 ± 2.04 vs. 8.01 ± 2.51, P = 0.094) between the two groups. Moreover, safety and compliance were similar in both groups. However, the SIM evening group was associated with shorter cecal intubation time (3.80 ± 1.81 vs. 4.42 ± 2.03, P < 0.001), higher BS (2.95 ± 0.26 vs. 2.88 ± 0.38, P = 0.04) in the right colon, and diminutive ADR (62.5% vs. 38.6%, P = 0.022) in the right colon, when compared to the SIM evening group. CONCLUSIONS The SIM addition to PEG in the evening of the day prior to colonoscopy can shorten cecal intubation time and improve BS scores and diminutive ADR of the right colon compared with the SIM addition to PEG in the morning of colonoscopy in bowel preparation.
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Zhang H, Liu J, Ma SL, Huang ML, Fan Y, Song M, Yang J, Zhang XX, Song QL, Gong J, Huang PX, Zhang H. Impact of simethicone on bowel cleansing during colonoscopy in Chinese patients. World J Clin Cases 2021; 9:2238-2246. [PMID: 33869599 PMCID: PMC8026841 DOI: 10.12998/wjcc.v9.i10.2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Four-liter polyethylene glycol (PEG) solutions are effective for bowel cleansing, but their large volume might hinder patient compliance. Due to the unique features of Asians, 4 L PEG might be a suboptimal bowel preparation in predominantly ethnically Asian countries. In view of this, a balance should be achieved between the volume and effectiveness. The ideal bowel cleansing regimen for a colonoscopy has yet to be determined in a Chinese population.
AIM To compare the cleansing efficacy of 3 L PEG plus simethicone with 4 L PEG.
METHODS A total of 291 patients were randomly allocated to two groups: Group 1 (n = 145) received 4 L split-dose PEG (4-P); group 2 (n = 146) received 3 L split-dose PEG plus simethicone (3-PS). Bowel-cleansing efficacy was evaluated by endoscopists using the Boston bowel preparation scale (BBPS) and the bubbles score.
RESULTS Although there were no significant differences in the total BBPS score or the adequate rate of bowel preparation between the two groups, the BBPS score of the right-side colon was significantly higher in the 3-SP group (2.37 ± 0.54 vs 2.21 ± 0.78; P = 0.04). Moreover, the use of simethicone significantly reduced bubbles in all colon segments (P < 0.001). The mean withdrawal time was significantly shorter in the 3-PS group (8.8 ± 3.4 vs 9.6 ± 2.3; P = 0.02). Furthermore, significantly more proximal adenomas were detected in the 3-PS group (53.6% vs 45.7%; P = 0.03). In addition, the proportions of patients with nausea and bloating were significantly lower in the 3-SP group (P < 0.01 for both). More patients in the 3-PS group expressed willingness to repeat the bowel preparation (87.7% vs 76.6%, P = 0.01).
CONCLUSION Three-liter PEG shows satisfactory bowel cleansing despite the decrease in dosage, and addition of simethicone with better bubble elimination and enhanced patient acceptance offers excellent potential impact on the detection of proximal adenomas in Chinese patients.
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Affiliation(s)
- Hu Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
- Department of Gastroenterology, The Eighth Hospital of Wuhan, Wuhan 430014, Hubei Province, China
| | - Jing Liu
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Song-Lin Ma
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Man-Lin Huang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Yan Fan
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Min Song
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Jing Yang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Xiao-Xia Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Qi-Long Song
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Jing Gong
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Ping-Xiao Huang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Heng Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
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Choi YI, Lee JJ, Chung JW, Kim KO, Kim YJ, Kim JH, Park DK, Kwon KA. Efficacy and Patient Tolerability Profiles of Probiotic Solution with Bisacodyl Versus Conventional Cleansing Solution for Bowel Preparation: A Prospective, Randomized, Controlled Trial. J Clin Med 2020; 9:jcm9103286. [PMID: 33066237 PMCID: PMC7602042 DOI: 10.3390/jcm9103286] [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: 09/21/2020] [Revised: 10/02/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
Although adequate bowel preparation is essential in screening colonoscopy, patient intolerability to bowel cleansing agents is problematic. Recently, a probiotic mixture solution with bisacodyl emerged to improve patient tolerability. We investigated the efficacy, safety, and patient tolerability profiles of probiotics with bisacodyl versus conventional polyethylene glycol (PEG) solution for bowel preparation for screening colonoscopies in healthy patients in this prospective, randomized, case-control study. In total, 385 volunteers were randomly assigned to receive 2 L of water + 200 mL of probiotic solution (case group, n = 195) or 4 L of PEG solution (control group, n = 190). The efficacy of the bowel cleansing was evaluated using the Ottawa scale system, polyp detection rate, and adenoma detection rate, and the patient tolerability profiles were assessed using a questionnaire. The demographics were not significantly different between groups. When the Ottawa score for each bowel segment was stratified into an adequate vs. inadequate level (Ottawa score ≤ 3 vs. >3), there were no statistical differences between groups in each segment of the colon. There were no significant differences in the polyp and adenoma detection rates between groups (38.42% vs. 32.42, p = 0.30; 25.79% vs. 18.97%, p = 0.11). The case group showed significantly fewer events than the control group, especially nausea, vomiting, and abdominal bloating events. Regarding the overall satisfaction grade, the case group reported significantly more “average” scores (95% vs. 44%, p < 0.001) and were more willing to use the same agents again (90.26% vs. 61.85%, p < 0.001). As patient compliance with bowel preparation agents is associated with an adequate level of bowel cleansing, a probiotic solution with bisacodyl might be a new bowel preparation candidate, especially in patients who show a poor compliance with conventional bowel preparation agents.
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Affiliation(s)
| | | | | | | | | | | | | | - Kwang An Kwon
- Correspondence: ; Tel.: +82-32-460-3778; Fax: +82-32-460-3408
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Li DF, Luo MH, Du QQ, Zhang HY, Tian YH, Liu TT, Shi RY, Xiong F, Lai MG, Li YX, Luo S, Song Y, Wu BH, Xu ZL, Zhang DG, Yao J, Wang LS. Efficacy of low-dose versus high-dose simethicone with polyethylene glycol for bowel preparation: A prospective randomized controlled trial. J Gastroenterol Hepatol 2020; 35:1488-1494. [PMID: 32128877 DOI: 10.1111/jgh.15022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Additional simethicone (SIM) can improve adequate bowel preparation and adenoma detection rate (ADR). However, there is no consensus on the optimal dose of SIM. In this study, we compared the adequate bowel preparation rate with supplementation of split-dose 2 L polyethylene glycol (PEG) with low-dose SIM (200 mg) versus high-dose SIM (1200 mg). METHODS This was a prospective, randomized, observer-blinded trial involving consecutive subjects undergoing colonoscopy. The primary outcome was adequate bowel preparation as assessed by Boston Bowel Preparation Scale (BBPS) score. RESULTS Four hundred subjects were randomly allocated to low-dose SIM or high-dose SIM group. Baseline characteristics were comparable in the two groups (P > 0.05). No significant between-group differences were observed with respect to total bubble scale (BS) (8.49 ± 1.00 vs 8.39 ± 1.10, P = 0.07), total BBPS score (8.70 ± 0.81 vs 8.29 ± 1.18, P = 0.98), ADR (33.68% vs 31.79%, P = 0.69) or withdrawal time (13 [range, 10-16] min vs 13 [10-15] min, P = 0.96). The intubation time in low-dose SIM group was significantly shorter than that in high-dose SIM group (8 (4-16) min vs 10 [6-17] min, P = 0.04). In addition, BS scores as well as diminutive ADR in right colon were superior in the low-dose SIM group (2.68 ± 0.59 vs 2.52 ± 0.73, P = 0.03 and 54.29% vs 30.30%, P = 0.046, respectively). CONCLUSION Addition of low-dose SIM to split-dose 2 L PEG was as effective as addition of high-dose SIM with respect to adequate bowel preparation, ADR and patient tolerance. However, low-dose SIM was superior with respect to intubation time, right colon BS scores, right colon diminutive ADR and cost savings.
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Affiliation(s)
- De-Feng Li
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Ming-Han Luo
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Qing-Qing Du
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Hai-Yang Zhang
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Yan-Hui Tian
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Ting-Ting Liu
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Rui-Yue Shi
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Feng Xiong
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Ming-Guang Lai
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Ying-Xue Li
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Su Luo
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Yang Song
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Ben-Hua Wu
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Ding-Guo Zhang
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Jun Yao
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Li-Sheng Wang
- Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
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de Groen PC. Using artificial intelligence to improve adequacy of inspection in gastrointestinal endoscopy. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.tgie.2019.150640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Zuberi BF, Shaikh MA, Ali FS, Rasheed T, Nawaz Z. Effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility: A single blinded, placebo control, randomized trial. Pak J Med Sci 2020; 36:172-176. [PMID: 32063954 PMCID: PMC6994877 DOI: 10.12669/pjms.36.2.1241] [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] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility. Methodology: A randomized, single blinded placebo control trial was done in patients undergoing oesophago-gastro-duodenoscopy for any indication at DOTs Endoscopy Suite, CHK during the period of April to June 2019. Informed consent was taken. Patients were randomly allocated in two groups. Group-A received placebo while Group-B received Simethicone. Evaluation of mucosal visibility was assessed at 4 sites (oesophagus, fundus, antrum & duodenum) by previously validated scoring. Mean of visibility scores were compared in two groups. Results: Two hundred and forty-eight patients were inducted and randomly allocate to two groups of 124 each. Mean of total sum of scores in Group-A was 8.14 ±2.44 and that of Group-B was 5.80 ±1.75 (p<0.001). Adequate visibility in Group-A was seen in 41.1% and that in Group-B was 78.2% (p<0.001). Conclusion: Use of Simethicone significantly improves mucosal visibility during OGD.
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Affiliation(s)
- Bader Faiyaz Zuberi
- Bader Faiyaz Zuberi, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Majid Ahmed Shaikh
- Majid Ahmed Shaikh, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Faiza Sadaqat Ali
- Faiza Sadaqat Ali, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Tazeen Rasheed
- Tazeen Rasheed, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Zunaira Nawaz
- Zunaira Nawaz Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Guo R, Wang YJ, Liu M, Ge J, Zhang LY, Ma L, Huang WY, Zhai HH. The effect of quality of segmental bowel preparation on adenoma detection rate. BMC Gastroenterol 2019; 19:119. [PMID: 31286888 PMCID: PMC6615148 DOI: 10.1186/s12876-019-1019-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/10/2019] [Indexed: 12/13/2022] Open
Abstract
Background The effectiveness in surveillance colonoscopy largely depends on the quality of bowel preparation. We aimed to investigate the quality of bowel preparation segmentally and its effect on Adenoma Detection Rate (ADR) and Advanced Adenoma Detection Rate (AADR) at corresponding bowel segments. Methods This is a single-centered and cross-sectional study. A consecutive of 5798 patients who underwent colonoscopy examination were included. Bowel preparation was evaluated based on Bowel Bubble Scale (BBS) in general and Boston Bowel Preparation Scale (BBPS) in each segment (right side, transverse and left side of colon) and total BBPS scores. The quality of bowel preparation was correlated with ADR and AADR. Results Four thousand nine hundred forty colonoscopies (14,820 bowel segments) were included in the final analysis. In which 30.9% scored 3, 57.5% scored 2, 11.2% scored 1 and 0.4% scored 0 on basis of BBPS. For each score, ADR were 10.8, 7.7, 4.9 and 3.2%, respectively; whereas AADR were 4.5, 2.8,1.8 and 1.6% (P < 0.05). 36.9% of the colonoscopies showed presence of minimal bubbles and 34.3% with no bubble. For bowels without bubbles and with a large amount of bubbles, ADR were 28.3 and 20.0% respectively; and AADR were 13.3 and 7.1% respectively. Conclusions Segmental bowels’ cleanliness and the amount of bubbles in bowels significantly affect ADR and AADR. The better the bowel preparation at each segment is and the less bubbles in the bowel there are, the higher ADR and AADR we got. We suggest repeating colonoscopy if any segment of the bowel preparation is poor, or if there is more bubbles, even if the total score of BBPS indicates good or fair bowel preparation.
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Affiliation(s)
- Rui Guo
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Street, Xicheng Area, Beijing, 100050, People's Republic of China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China.,National Clinical Research Center for Digestive Diseases, Beijing, 100050, China.,Department of Gastroenterology, Beijing Shijingshan Hospital, Teaching Hospital of Capital Medical University, Beijing, 100043, China
| | - Yong-Jun Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Street, Xicheng Area, Beijing, 100050, People's Republic of China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China.,National Clinical Research Center for Digestive Diseases, Beijing, 100050, China
| | - Mo Liu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jun Ge
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Street, Xicheng Area, Beijing, 100050, People's Republic of China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China.,National Clinical Research Center for Digestive Diseases, Beijing, 100050, China
| | - Ling-Ye Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Street, Xicheng Area, Beijing, 100050, People's Republic of China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China.,National Clinical Research Center for Digestive Diseases, Beijing, 100050, China
| | - Ling Ma
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Street, Xicheng Area, Beijing, 100050, People's Republic of China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China.,National Clinical Research Center for Digestive Diseases, Beijing, 100050, China
| | - Wen-Yu Huang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Street, Xicheng Area, Beijing, 100050, People's Republic of China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China.,National Clinical Research Center for Digestive Diseases, Beijing, 100050, China
| | - Hui-Hong Zhai
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Street, Xicheng Area, Beijing, 100050, People's Republic of China. .,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China. .,National Clinical Research Center for Digestive Diseases, Beijing, 100050, China.
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Rishi M, Kaur J, Ulanja M, Manasewitsch N, Svendsen M, Abdalla A, Vemala S, Kewanyama J, Singh K, Singh N, Gullapalli N, Osgard E. Randomized, double-blinded, placebo-controlled trial evaluating simethicone pretreatment with bowel preparation during colonoscopy. World J Gastrointest Endosc 2019; 11:413-423. [PMID: 31236194 PMCID: PMC6580307 DOI: 10.4253/wjge.v11.i6.413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/01/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The presence of small air bubbles and foam are an impediment to a successful colonoscopy. They impair an endoscopist’s view and diminish the diagnostic accuracy of the study. This has been particularly noted to be of concern with the switch to lower volume polyethylene glycol (PEG) and bisacodyl combination preparation.
AIM To evaluate the effect of oral simethicone addition to bowel preparation on intraluminal bubbles reduction during colonoscopy.
METHODS Described is a prospective, randomized, multi-center, double-blinded, placebo-controlled study to evaluate the use of premixed simethicone formulation with split-regimen, low-volume PEG-bisacodyl combination bowel preparation for 168 outpatients undergoing screening, surveillance, and diagnostic colonoscopies. Primary outcome includes evaluation of bubbles during colonoscopy graded using the Intraluminal Bubbles Scale. Secondary outcomes include evaluation of the Boston Bowel Preparation Scale (BBPS), total number of polyps, polyp size differentiation, polyp laterality, adenoma detection, mass detection, cecal insertion time, withdrawal time, and patient-reported adverse events.
RESULTS Higher Intraluminal Bubbles grades III and IV (less than 75% of the mucosa cleared of bubbles/foam requiring intervention with simethicone infused wash) were detected in the placebo group [Simethicone n = 4/84 vs Placebo n = 20/84 (P = 0.007)]. BBPS total score was 7.42 [standard deviation (SD) = ± 1.51] in the simethicone group and 7.28 (SD = ± 1.44) in the placebo group (P = 0.542) from a total of 9. Significantly higher number of adenomas were detected in the simethicone group (P = 0.001).
CONCLUSION The addition of simethicone to bowel preparation is well advised for its anti-foaming properties. The results of this study suggest that addition of oral simethicone can improve bowel wall visibility.
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Affiliation(s)
- Mohit Rishi
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Renown Regional Medical Center, Reno, NV 89502, United States
| | - Jaskarin Kaur
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Renown Regional Medical Center, Reno, NV 89502, United States
| | - Mark Ulanja
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Renown Regional Medical Center, Reno, NV 89502, United States
| | - Nicholas Manasewitsch
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Renown Regional Medical Center, Reno, NV 89502, United States
| | - Molly Svendsen
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Renown Regional Medical Center, Reno, NV 89502, United States
| | - Abubaker Abdalla
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Renown Regional Medical Center, Reno, NV 89502, United States
| | - Shashank Vemala
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Renown Regional Medical Center, Reno, NV 89502, United States
| | - Julie Kewanyama
- Gastroenterology Consultants, LTD, Reno, NV 89502, United States
| | - Karmjit Singh
- Aureus Univeristy School of Medicine, Oranjestad 31C, Aruba
| | - Nirmal Singh
- American International Medical University, Gross Islet 7610, Saint Lucia
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Renown Regional Medical Center, Reno, NV 89502, United States
| | - Eric Osgard
- Gastroenterology Consultants, LTD, Reno, NV 89502, United States
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