SEDATION IN COLONOSCOPY BY USING THREE DIFFERENT PROPOFOL INFUSION METHODS AND ANALYSIS OF PLASMA CONCENTRATION LEVELS: A PROSPECTIVE COMPARATIVE STUDY

NEW BOWEL PREPARATION TECHNIQUE FOR COLONOSCOPY: CLINICAL TRIAL COMPARING AQUANET AND MANNITOL

Background:

Fifty-five percent of Americans aged 50-65 are submitted to colonoscopy. For over 65-year, this number increases to 64%. In Brazil, it is forecast that the population submitted to colonoscopy will grow, even though inadequate preparation is still a major problem.

Aim:

To analyze the quality of a new intestinal preparation technique, Aquanet EC-2000^®, compared to oral Mannitol solution.

Methods:

This prospective longitudinal study enrolled 200 patients with indication for colonoscopy. The sample was randomly allocated to two groups of 100; one group received Aquanet EC-2000^® to prepare for colonoscopy and the other Mannitol solution. The Boston scale was used to analyze the results.

Results:

As expected both preparations produced similar results with the bowel cleansing of the different regions of the colon being classified as Boston scale 3 (excellent) in most patients (p>0.05).

Conclusion:

The results of bowel preparation using Aquanet EC-2000^® were similar to using Mannitol solution.

THE IMPORTANCE OF COLONOSCOPY IN INFLAMMATORY BOWEL DISEASES

INTRODUCTION

Endoscopic evaluation, particularly the macroscopic mucosal and histological results of ileocolic biopsies, is essential for the management of inflammatory bowel disease. Endoscopic appearance is not always sufficient to differentiate Crohn's disease and ulcerative colitis, but there are some characteristics that favor one or another diagnosis. Both diseases have an increased incidence of colorectal carcinoma; so, surveillance colonoscopy is important for detecting early neoplastic lesions.

OBJECTIVE

To update the importance of endoscopy in the evaluation, diagnosis and prognosis of inflammatory bowel disease.

METHOD

Search was done in the scientific literature of the TRIP database, chosen from clinical questions (PICO) with the following descriptors: "inflammatory bowel disease", "endoscopy/colonoscopy", "Crohn's disease", "ulcerative colitis" and "diagnosis/treatment".

RESULTS

Endoscopic investigation in patients with chronic colitis is quite accurate for the differential diagnosis between ulcerative colitis and Crohn's disease. Endoscopy is indicated for ulcerative colitis during severe crisis due to its prognostic value. Another accepted indication for endoscopy in inflammatory bowel disease is its use in the screening for dysplastic lesion.

CONCLUSION

Ileocolonoscopy allows an accurate diagnosis of Crohn's disease or ulcerative colitis in up to 90% of cases. The healing of the mucosa assessed by endoscopy after treatments despite not being consensus is still the gold-standard in the evaluation of remission of the disease. Colonoscopy is essential for long-term cancer surveillance and in the future the implementation of Confocal Laser Endomicroscopy seems to be very promising in assessing the initial dysplasia.

Comparison of bolus versus continuous infusion of propofol for procedural sedation: a meta-analysis

OBJECTIVE

To compare the efficacy and safety of bolus infusion versus continuous infusion for propofol sedation.

METHODS

We searched OVID-MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, Koreamed, and Kmbase databases to identify all randomized controlled trials that compared bolus infusion with continuous infusion for propofol sedation. We evaluated propofol dose used, procedure, sedation, and recovery time. The incidences of respiratory and cardiovascular complications were also evaluated.

RESULTS

A total of 12 studies of 963 patients were included. The required propofol dose was significantly higher in continuous infusion compared with bolus infusion (standardized mean difference [SMD]: -0.44; 95% confidence interval [CI]: -0.71 to -0.16; I² = 84%). Sedation time was significantly longer in continuous infusion compared with bolus infusion (mean difference [MD]: -8.58 min; 95% CI: -15.13 to -2.03; I² = 44%). The recovery time and incidences of desaturation, airway intervention, hypotension, and bradycardia were comparable between bolus and continuous infusion.

CONCLUSIONS

Propofol sedation by continuous infusion required a higher dose of propofol compared with bolus infusion, but the recovery time and frequency of complications were similar.

COLONOSCOPY: RANDOMIZED COMPARATIVE STUDY OF INSUFFLATION WITH CARBON DIOXIDE VERSUS AIR

Background:

In Brazil, an increasing number of people are submitted to colonoscopy, either for screening or for therapeutic purposes.

Aim:

To evaluate whether there are advantages of using carbon dioxide (CO₂) over air for insufflation.

Methods:

Two hundred and ten of 219 patients were considered eligible for this study and were randomized into two groups according to the gas insufflation used: Air Group (n=104) and CO₂ Group (n=97). The study employed a double-blind design.

Results:

The Air and CO₂ Groups were similar in respect to bowel preparation evaluated using the Boston scale, age, gender, previous surgery, maneuvers necessary for the advancement of the device, and presence of polyps, tumors or signs of diverticulitis. However, “waking up with pain” and “pain at discharge” were more prevalent in the Air Group, albeit not statistically significant, with post-exam bloating seen only in the Air Group. The responses to a questionnaire, applied to analyze the late post-exam period, showed more comfort with the use of CO₂.

Conclusions:

The use of CO₂ is better than air as it avoids post-examination bloating, thereby providing greater comfort to patients.