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Liang T, Li SL, Peng YC, Chen Q, Chen LW, Lin YJ. Efficacy and Safety of Oral Hydration 1 Hour After Extubation of Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial. J Cardiovasc Nurs 2022; Publish Ahead of Print:00005082-990000000-00044. [PMID: 36730988 DOI: 10.1097/jcn.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Thirst is one of the most common and uncomfortable symptoms in patients after cardiac surgery. The postextubation time for early oral hydration (EOH) remains unclear, and there is a lack of studies on its safety and effectiveness. OBJECTIVE The aim of this study was to investigate the effects of oral hydration 1 hour after extubation on thirst, salivary pH, salivary flow, oral mucosa, halitosis, gastrointestinal adverse reactions, aspiration pneumonia, and satisfaction in patients undergoing cardiac surgery. METHODS Eighty-four patients who underwent cardiac surgery were randomly assigned into 2 groups, for either conventional oral hydration (COH) or EOH. The EOH group drank 30 mL of warm water 1 hour post extubation and thereafter 50 mL hourly for 4 hours. The COH group had nil per os for 4 hours after extubation. If no dysphagia was evident after 4 hours, the patients were instructed to slowly drink water. Thirst intensity was evaluated every hour before the intervention. Nausea and vomiting were recorded after drinking water. The salivary pH, unstimulated salivary flow rate, oral odor, and oral mucosal moisture were evaluated at 1 hour post extubation, immediately before the intervention, and at 4 hour post intervention. Aspiration pneumonia data were collected within 72 hours post intervention. Satisfaction was assessed before leaving the intensive care unit. RESULTS The scores for thirst (3.38 ± 1.04; F = 306.21, P < .001), oral mucosa (2.03 ± 0.74; P < .001), and halitosis (2.77 ± 0.63; P < .001) in the EOH group were significantly lower than those in the COH group. The EOH group had significantly higher salivary pH (6.44 ± 1.06; P < .001), unstimulated salivary flow rates (0.18 ± 0.08; P < .001), and patient satisfaction (4.28 ± 0.45; P < .001) than the COH group. Nausea and vomiting did not differ significantly between groups (P = .60). Aspiration pneumonia was not observed in either group. CONCLUSIONS Oral hydration 1 hour after extubation significantly alleviated thirst and stabilized the oral environment without gastrointestinal adverse reactions or aspiration pneumonia, and with increased patient satisfaction.
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Cadoni S, Ishaq S, Hassan C, Falt P, Fuccio L, Siau K, Leung JW, Anderson J, Binmoeller KF, Radaelli F, Rutter MD, Sugimoto S, Muhammad H, Bhandari P, Draganov PV, de Groen P, Wang AY, Yen AW, Hamerski C, Thorlacius H, Neumann H, Ramirez F, Mulder CJJ, Albéniz E, Amato A, Arai M, Bak A, Barret M, Bayupurnama P, Cheung R, Ching HL, Cohen H, Dolwani S, Friedland S, Harada H, Hsieh YH, Hayee B, Kuwai T, Lorenzo-Zúñiga V, Liggi M, Mizukami T, Mura D, Nylander D, Olafsson S, Paggi S, Pan Y, Parra-Blanco A, Ransford R, Rodriguez-Sanchez J, Senturk H, Suzuki N, Tseng CW, Uchima H, Uedo N, Leung FW. Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations. Gastrointest Endosc 2021; 93:1411-1420.e18. [PMID: 33069706 DOI: 10.1016/j.gie.2020.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. METHODS Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. RESULTS In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). CONCLUSIONS The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.
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Affiliation(s)
- Sergio Cadoni
- CTO Hospital, Digestive Endoscopy Unit, Iglesias, Italy
| | - Sauid Ishaq
- Russell Hall, Dept. of Gastroenterology, Birmingham, United Kingdom; Birmingham City University, Birmingham, United Kingdom
| | - Cesare Hassan
- Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
| | - Přemysl Falt
- University Hospital and Faculty of Medicine, Palacky University, Olomouc, Czech Republic; Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Lorenzo Fuccio
- S. Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, Bologna, Italy
| | - Keith Siau
- JAG Clinical Fellow, JAG, Royal College of Physicians, London, United Kingdom
| | - Joseph W Leung
- Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and University of California Davis School of Medicine, Sacramento, California, USA
| | - John Anderson
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom
| | - Kenneth F Binmoeller
- California Pacific Medical Center, Interventional Endoscopy Services, San Francisco, California, United States
| | | | - Matt D Rutter
- University Hospital North Tees NHS, Department of Gastroenterology, Stockton-on-Tees, United Kingdom; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Shinya Sugimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Pradeep Bhandari
- Portsmouth University Hospital, Dept. of Gastroenterology, Portsmouth, United Kingdom
| | | | - Piet de Groen
- University of Minnesota, Division of Gastroenterology, Minneapolis, Minnesota, United States
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States
| | - Andrew W Yen
- Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and University of California Davis School of Medicine, Sacramento, California, USA
| | - Chris Hamerski
- California Pacific Medical Center, Interventional Endoscopy Services, San Francisco, California, United States
| | - Henrik Thorlacius
- Lund University Surgery, Department of Gastrointestinal Surgery, Malmö, Sweden
| | - Helmut Neumann
- University Medical Center, Interventional Endoscopy Center, Medizinische Klinik und Poliklinik, Mainz, Germany
| | | | - Chris J J Mulder
- VU University Medical Center, Department of Gastroenterology, Amsterdam, The Netherlands
| | - Eduardo Albéniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Arnaldo Amato
- Ospedale Valduce, Gastroenterology Unit, Como, Italy
| | - Makoto Arai
- Chiba University, Gastroenterology Department, Chiba, Japan
| | - Adrian Bak
- University of British Columbia, Department of Medicine, Kelowna, Canada
| | | | - Putut Bayupurnama
- Division of Gastroenterology and Hepatology, Internal Medicine Department, Faculty of Medicine, Gadjah Mada University, Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, VA Palo Alto, California, United States
| | - Hey-Long Ching
- Sheffield Teaching Hospitals, Gastroenterology Department, Sheffield, United Kingdom
| | - Hartley Cohen
- Department of Medicine, VA Greater Los Angeles Health Care System, Los Angeles, United States; David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California, United States
| | - Sunil Dolwani
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, VA Palo Alto, California, United States
| | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Gastroenterology, Matsudo, Chiba, Japan
| | - Yu-Hsi Hsieh
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan
| | - Bu Hayee
- King's College Hospital NHS foundation Trust, Gastroenterology Department, London, United Kingdom
| | - Toshio Kuwai
- NHO Kure Medical Center and Chugoku Cancer Center, Gastroenterology Department, Kure, Japan
| | | | - Mauro Liggi
- ASSL Carbonia, Sirai Hospital, Digestive Endoscopy Unit, Carbonia, Italy
| | - Takeshi Mizukami
- NHO Kurihama Medical and Addiction Center, Endoscopy Center, Yokosuka, Japan
| | - Donatella Mura
- ASSL Carbonia, Sirai Hospital, Digestive Endoscopy Unit, Carbonia, Italy
| | - David Nylander
- Newcastle Upon Tyne NHS Foundation Trust, Gastroenterology Department, Newcastle Upon Tyne, United Kingdom
| | - Snorri Olafsson
- Telemark Hospital, Gastroenterology Department, Skien, Norway
| | - Silvia Paggi
- Ospedale Valduce, Gastroenterology Unit, Como, Italy
| | - Yanglin Pan
- Xijing Hospital, Department of Gastroenterology, Xian, Republic of China
| | - Adolfo Parra-Blanco
- NIHR Nottingham Biomedical Research Centre, Department of Gastroenterology, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Rupert Ransford
- Endoscopy Department Hereford County Hospital, Hereford, United Kingdom
| | | | - Hakan Senturk
- Bezmialem Vakif University Medicine Faculty, Department of Medicine, Istanbul, Turkey
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Chih-Wei Tseng
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan
| | - Hugo Uchima
- Hospital Germans Triasi i Pujol, Teknon Medical Center, Gastroenterology, Barcelona, Spain
| | - Noriya Uedo
- Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
| | - Felix W Leung
- Department of Medicine, VA Greater Los Angeles Health Care System, Los Angeles, United States; David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California, United States
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Randomized Controlled Trial of Polyethylene Glycol versus Oral Sodium Phosphate for Bowel Preparation in Unsedated Colonoscopy. Gastroenterol Res Pract 2020; 2020:6457079. [PMID: 32908496 PMCID: PMC7463375 DOI: 10.1155/2020/6457079] [Citation(s) in RCA: 4] [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: 05/07/2020] [Revised: 07/18/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022] Open
Abstract
Aim To identify the most effective laxative for bowel preparation in unsedated colonoscopy. Methods Between April 2019 and April 2020, a total of 586 outpatients scheduled for unsedated colonoscopy at the First Hospital of Jilin University (Changchun, China) were randomized into one of two groups, namely, the polyethylene glycol (PEG) group or the oral sodium phosphate solution (OSP) group. The cleaning efficiency and other relevant clinical parameters were compared between the two groups. Results Each group consisted of 293 patients. There were no significant differences in gender, body mass index, and history of abdominal surgery between the two groups. There were more cases of laxative intolerance in the PEG group than in the OSP group (7.5% vs. 0.7%, P < 0.05). After tube insertion, we found that the cleaning efficiency of OSP was better than that of PEG (P < 0.05). After cleaning, there was no significant difference in bowel cleanliness between the two groups (P > 0.05). The colonoscopic insertion time of the PEG group was significantly shorter than that of the OSP group (10.0 vs. 12.0 min, P = 0.002), and colonoscopic insertion was more difficult in the OSP group than in the PEG group (P = 0.036). The VAS score of the PEG group patients was significantly lower than that of OSP group patients (4.0 ± 1.3 vs. 5.2 ± 1.7, P ≤ 0.001). There were no significant differences in the cecal intubation rate and the detection rate of polyps and ulcers/erosion between the two groups. Conclusion The cleaning efficiency and tolerability of OSP were preferable to those of PEG, but there was no significant difference in bowel cleanliness after washing the colon and suctioning the fluid. Compared with patients of the OSP group, those of the PEG group required a shorter colonoscopic insertion time and reported a more comfortable experience. Therefore, for cases that are tolerant of PEG, PEG is a better choice for unsedated colonoscopy.
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Facciorusso A, Triantafyllou K, Murad MH, Prokop LJ, Tziatzios G, Muscatiello N, Singh S. Compared Abilities of Endoscopic Techniques to Increase Colon Adenoma Detection Rates: A Network Meta-analysis. Clin Gastroenterol Hepatol 2019; 17:2439-2454.e25. [PMID: 30529731 DOI: 10.1016/j.cgh.2018.11.058] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Adenoma detection rate (ADR) is a quality metric for colorectal cancer screening. We performed a systematic review and network meta-analysis to assess the overall and comparative efficacies of different endoscopic techniques in adenoma detection. METHODS We performed a systematic review of published articles and abstracts, through March 15, 2018, to identify randomized controlled trials of adults undergoing colonoscopy that compared the efficacy of different devices in detection of adenomas. Our final analysis included 74 2-arm trials that comprised 44948 patients. These studies compared efficacies of add-on devices (cap, endocuff, endo-rings, G-EYE), enhanced imaging techniques (chromoendoscopy, narrow-band imaging, flexible spectral imaging color enhancement, blue laser imaging), new scopes (full-spectrum endoscopy, extra-wide-angle-view colonoscopy, dual focus), and low-cost optimizing existing resources (water-aided colonoscopy, second observer, dynamic position change), alone or in combination with high-definition colonoscopy or each other. Primary outcome was increase in ADR. We performed pairwise and network meta-analyses, and appraised quality of evidence using GRADE. RESULTS Low-cost optimizing existing resources (odds ratio [OR], 1.29; 95% CI,1.17-1.43), enhanced imaging techniques (OR,1.21; 95% CI, 1.09-1.35), and add-on devices (OR,1.18; 95% CI, 1.07-1.29) were associated with a moderate increase in ADR compared with high-definition colonoscopy; there was low to moderate confidence in estimates. Use of newer scopes was not associated with significant increases in ADR compared with high-definition colonoscopy (OR, 0.98; 95% CI, 0.79-1.21). In our comparative efficacy analysis, no specific technology for increasing ADR was superior to others. We did not find significant differences between technologies in detection of advanced ADR, polyp detection rate, or mean number of adenomas/patient. CONCLUSIONS In a network meta-analysis of published trials, we found that low-cost optimization of existing resources to be as effective as enhanced endoscopic imaging, or add-on devices, in increasing ADR during high-definition colonoscopy.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohammad Hassan Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Larry J Prokop
- Department of Library Services, Mayo Clinic, Rochester, Minnesota
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Siddharth Singh
- Division of Gastroenterology and Biomedical Informatics, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, University of California San Diego, La Jolla, California
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Li L, Shu W, Li Z, Liu Q, Wang H, Feng B, Ouyang YQ. Using Yoga Nidra Recordings for Pain Management in Patients Undergoing Colonoscopy. Pain Manag Nurs 2019; 20:39-46. [DOI: 10.1016/j.pmn.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 02/23/2018] [Accepted: 04/01/2018] [Indexed: 12/19/2022]
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Abstract
BACKGROUND/AIMS To compare water exchange (WE) method with conventional air insufflation (AI) method for colonoscopy, evaluating the technical quality, screening efficacy, and patients' acceptance. MATERIALS AND METHODS Electronic databases were systematically searched for randomized controlled trials comparing WE colonoscopy with AI colonoscopy. The pooled data of procedure-associated and patient-related outcomes were assessed, using the weighted mean difference (WMD) with 95% confidence interval (CI) for continuous variables and relative risk (RR) with 95% CI for dichotomous variables, respectively. RESULTS A total of 13 studies involving 7056 patients were included. The cecum intubation rate was similar between WE and AI methods (RR = 1.01, 95% CI = 0.99-1.02,P = 0.37); however, a significantly longer cecum intubation time was shown in WE group (WMD = 1.56, 95% CI = 0.75-2.37,P = 0.002). Compared with AI, WE was associated with a higher risk of adenoma detection rate (ADR) (RR = 1.28, 95% CI = 1.18-1.38,P < 0.00001) and polyp detection rate (PDR) (RR = 1.30, 95% CI = 1.21-1.39,P < 0.00001). Patients in WE group experienced significantly less maximum pain score (WMD = -1.99, 95% CI = -2.68 to -1.30,P < 0.00001) and less requested on-demand sedation (RR = 0.58, 95% CI = 0.44-0.77,P = 0.0002). Likewise, they also experienced less abdominal compression (RR = 0.62, 95% CI = 0.51-0.74,P < 0.00001) and reposition (RR = 0.74, 95% CI = 0.63-0.86,P = 0.0001). Moreover, patients' willingness to repeat colonoscopy was significantly greater for WE (RR = 1.14, 95% CI = 1.07-1.21,P < 0.0001). CONCLUSION This meta-analysis confirmed that WE method could significantly increase ADR/PDR and improve patients' acceptance of colonoscopy, while reducing the degree of pain and minimize the need for on-demand sedation and adjunct maneuvers, despite requiring more cecal intubation time.
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Affiliation(s)
- Yang Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Qing-Ke Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiu-Li Dong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Piao-Piao Jin
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Fuccio L, Frazzoni L, Hassan C, La Marca M, Paci V, Smania V, De Bortoli N, Bazzoli F, Repici A, Rex D, Cadoni S. Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies. Gastrointest Endosc 2018; 88:589-597.e11. [PMID: 29981753 DOI: 10.1016/j.gie.2018.06.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Water-aided colonoscopy techniques, such as water immersion (WI) and water exchange (WE), have shown different results regarding adenoma detection rate (ADR). We determined the impact of WI and WE on ADR and other procedural outcomes versus gas (air, AI; CO2) insufflation colonoscopy. METHODS A systematic search of multiple databases for randomized controlled trials comparing WI and/or WE with AI and/or CO2 and reporting ADR was conducted. A network meta-analysis with mixed comparisons was performed. Primary outcome was ADR (overall, in the right side of the colon and by colonoscopy indication). RESULTS Seventeen randomized controlled trials (10,350 patients) were included. WE showed a significantly higher overall ADR versus WI (odds ratio [OR], 1.31; 95% credible interval [CrI], 1.12-1.55) versus AI (OR, 1.40; CrI, 1.22-1.62) versus CO2 (OR, 1.48; 95% CrI, 1.15-1.86). WE achieved the highest ADR also in the right side of the colon and in colorectal cancer screening cases (both significant vs AI and WI) as well as in patients taking a split-dose preparation (significant vs all the other techniques). The Boston Bowel Preparation Scale cleanliness score (vs AI and WI) was significantly higher for WE. Both WI and WE showed increased proportion of unsedated examinations and decreased real-time insertion pain, with WE being the least-painful insertion technique. Withdrawal time was comparable across techniques, but WE showed the longest insertion time (3-5 additional minutes). CONCLUSIONS WE significantly increases overall ADR, ADR in screening cases, and in the right side of the colon; it also improves colon cleanliness but requires a longer insertion time.
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Affiliation(s)
- Lorenzo Fuccio
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Marina La Marca
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Valentina Paci
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Veronica Smania
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicola De Bortoli
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano (MI), Italy
| | - Douglas Rex
- Division of Gastroenterology/Hepatology, Indiana University Hospital, Indianapolis, Indiana, USA
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
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Shi X, Tian D, Ye X, Wu Q, Pan Y, Yang Z, Fan D. Is water exchange superior to water immersion in detecting adenomas during colonoscopies? Results from a Bayesian network meta-analysis. Oncotarget 2018; 9:30679-30693. [PMID: 30093978 PMCID: PMC6078142 DOI: 10.18632/oncotarget.25504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/08/2018] [Indexed: 12/13/2022] Open
Abstract
AIM Water-assisted colonoscopy (water exchange [WE] and water immersion [WI]) has been shown to improve the adenoma detection rate. However, few studies have compared these two methods head-to-head. Thus, we conducted a network meta-analysis to integrate both direct and indirect evidence comparing the effectiveness of these two procedures. METHOD We searched PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for original papers and abstracts published up to March 2018. Randomized controlled trials (RCTs) reporting data in accordance with the eligibility criteria were included in this study. We performed a Bayesian random effects network meta-analysis with mixed comparisons. RESULTS Twenty-nine studies (n = 11464 patients) including 6 direct and 23 indirect comparisons were included in this network meta-analysis. There was a statistically significant difference in the efficacy of adenoma detection when WE was compared with WI (risk ratio [RR]: 1.2, 95% credible interval [CrI]: 1.1-1.3), air insufflation (AI; RR: 1.3, 95% CrI: 1.1-1.4), and carbon dioxide (CO2) insufflation (RR: 1.2, 95% CrI: 1.1-1.5). The different methods were ranked in order from the most to least effective in adenoma detection as follows: WE, WI, AI, and CO2. Moreover, although there were no significant differences in pain scores, willingness to repeat, caecal intubation rate, or total procedure time between WI and WE colonoscopy, WE required a longer caecal intubation time than WI. CONCLUSION This network meta-analysis supposes that WE may be superior to WI in detecting adenomas during colonoscopies without affecting other technical features or patient acceptance.
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Affiliation(s)
- Xin Shi
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
| | - Dan Tian
- Office of Educational Administration, Fourth Military Medical University, Xi’an, China
| | - Xiaofei Ye
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Qiong Wu
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
| | - Yanglin Pan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
| | - Zhiping Yang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
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Siau K, Cadoni S. Colonoscope Insertion: Is the Future Underwater. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:163-165. [PMID: 29998160 PMCID: PMC6029225 DOI: 10.1159/000485038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 10/27/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Keith Siau
- JAG Research Fellow, Royal College of Physicians, London
- Dudley Group Hospitals NHS Foundation Trust, Dudley, UK
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
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Zhang Z, Wu Y, Sun G, Zhang J, Li J, Qiu C, Zheng X, Wang B, Yang L, Wang X. Bayesian network meta-analysis: Efficacy of air insufflation, CO 2 insufflation, water exchange, and water immersion in colonoscopy. Dig Endosc 2018; 30:321-331. [PMID: 29334136 DOI: 10.1111/den.13012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Colonoscopy is an excellent screening tool for colorectal cancer. There are four colonoscopy techniques: air insufflation, CO2 insufflation, water exchange, and water immersion. Some studies reported that the latter three methods are better than the criterion standard (air insufflation), whereas some studies did not. In order to evaluate the efficacy of the four colonoscopy techniques, a network meta-analysis was carried out. METHODS We searched randomized controlled trials (RCT) published up to September 2017 from PubMed, Embase, Cochrane library, and Web of Science. Studies referencing the comparison between at least two of air insufflation, CO2 insufflation, water exchange, and water immersion were selected. Primary outcomes included pain score during insertion, polyp detection rate, and adenoma detection rate, and secondary outcomes included cecal intubation time and cecal intubation rate. Mean differences or odds ratios and their corresponding 95% credible intervals were pooled with Bayesian modeling. RESULTS Forty RCT with 13 734 patients were included in this network meta-analysis. Our analysis showed that air insufflation had the highest pain score (surface under the cumulative ranking curve [SUCRA]: 98.8%) and the lowest detection rate of adenoma (SUCRA: 21.3%) and polyp (SUCRA: 16.8%). Water exchange had the lowest pain score (SUCRA: 1.1%) and highest detection rate of adenoma (SUCRA: 96.0%) and polyp (SUCRA: 98.9%), although it led to the longest cecal intubation time (SUCRA: 86.9%). CONCLUSIONS Air insufflation might be the most unsatisfactory colonoscopy. Meanwhile, water exchange might be the most efficient colonoscopy.
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Affiliation(s)
- Zhen Zhang
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Yifeng Wu
- Tianjin People's Hospital Tianjin Union Medical Center, Tianjin, China
| | - Guangge Sun
- Tianjin People's Hospital Tianjin Union Medical Center, Tianjin, China
| | - Jing Zhang
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Jiaxin Li
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Chongyang Qiu
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Xin Zheng
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Botao Wang
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Lei Yang
- Tianjin Institute of Acute Abdominal Disease of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Ximo Wang
- Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
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Patel AM, Green J, Jowhari F, Hookey L. Use of warm carbon dioxide insufflators does not affect intra-colonic gas temperature and has no effect on polyp detection rate during colonoscopy - a randomized controlled trial. Endosc Int Open 2017; 5:E683-E689. [PMID: 28691054 PMCID: PMC5500117 DOI: 10.1055/s-0043-107779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/02/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Methods to improve polyp detection during colonoscopy have been investigated, with conflicting results for warm water irrigation. Carbon Dioxide (CO 2) warmed to 37 °C may have similar or more pronounced effects on bowel motility. This study aimed to assess whether warmed CO 2 would improve polyp detection compared to room temperature air insufflation. PATIENTS AND METHODS This was a double-blind, randomized controlled trial that enrolled 204 patients undergoing screening or surveillance outpatient colonoscopy. The primary outcome was polyp per patient detection rate. Secondary outcomes included adenoma per patient detection rates, bowel spasm, and patient comfort. RESULTS The trial was terminated after an interim analysis determined futility. Between the warmed CO 2 and room air groups, no significant differences were found in the per-colonoscopy polyp detection rate ( P = 0.57); overall polyp detection rate ( P = 0.69); or adenoma detection rates ( P = 0.74). More patients in the room temperature group had lower spasm scores (p = 0.02); however, there was a trend towards greater patient comfort in the warmed CO 2 group ( P = 0.054). An ex-vivo study showed a significant difference between exiting CO 2 temperature at the insufflator end vs. delivered CO 2 temperature at the colonoscope tip end. The temperature of insufflation at the tip of the colonoscope was not different when using warmed vs. unwarmed insufflation ( P = 0.62). CONCLUSION When compared with room air insufflation, warmed CO 2 insufflation did not affect polyp detection rates.
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Affiliation(s)
- Akash M. Patel
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen’s University, Kingston, Ontario
| | - Jordan Green
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen’s University, Kingston, Ontario
| | - Fahd Jowhari
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen’s University, Kingston, Ontario
| | - Lawrence Hookey
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen’s University, Kingston, Ontario,Corresponding author Lawrence Hookey Division of GastroenterologyHotel Dieu Hospital166 Brock StreetKingston, Ontario, CanadaK7L 5G2+613 544 3400, ext 2292+614 544 3114
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12
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Comparison of carbon dioxide and air insufflation during consecutive EGD and colonoscopy in moderate-sedation patients: a prospective, double-blind, randomized controlled trial. Gastrointest Endosc 2017; 85:1255-1262. [PMID: 27889545 DOI: 10.1016/j.gie.2016.10.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopy is performed with air insufflation and is usually associated with abdominal pain. It is well recognized that carbon dioxide (CO2) is absorbed more quickly into the body than air; however, to date, few studies have investigated the use of CO2 insufflation during consecutive EGD and colonoscopy (CEC). Thus, this study evaluated the efficacy of CO2 insufflation compared with air insufflation in CEC. METHODS From March 2014 to April 2016, a total of 215 consecutive patients were randomly assigned to receive CO2 insufflation (CO2 group, n = 108) or air insufflation (air group, n = 107). Abdominal pain after CEC was recorded on a visual analogue scale (VAS). The amount of sedatives administered, use of analgesics, polyp detection rate (PDR), adenoma detection rate (ADR), abdominal circumference, and adverse events were also analyzed. RESULTS Baseline patient characteristics were not significantly different between the groups. Abdominal pain on the VAS in the CO2 group and air group 1 hour after CEC was, respectively, 13.8 and 20.1 (P = .010), 3 hours after CEC was 8.3 and 12.5 (P = .056), 6 hours after CEC was 3.5 and 5.3 (P = .246), and 1 day after CEC was 1.8 and 3.4 (P = .192). The dose of sedative administered, analgesic usage, PDR, ADR, and adverse events were not statistically different between the groups. However, the increase in abdominal circumference was significantly higher in the air group than in the CO2 group. CONCLUSIONS CO2 insufflation was superior to air insufflation with regard to the pain score on the VAS in the hour after CEC. (Clinical trial registration number: KCT0001491.).
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14
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Abstract
Ischemic colitis (IC) is a common reason of acute lower gastrointestinal bleeding, and it is frequently seen in elderly people. In recent years, both the incidence and prevalence of IC have been rising. Most episodes of IC are transient and self-limited and only a minority of cases are severe. IC often has missed and delayed diagnosis. This review mainly focuses on the progress in the understanding of the diagnosis and therapy of IC.
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Subramaniam S, Kandiah K, Bhandari P. CO2 insufflation or warm water infusion for unsedated colonoscopy: A randomized controlled trial in patients with chronic constipation in China. Saudi J Gastroenterol 2016; 22:1-2. [PMID: 26831600 PMCID: PMC4763522 DOI: 10.4103/1319-3767.173752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sharmila Subramaniam
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK,Address for correspondence: Dr. Sharmila Subramaniam, Queen Alexandra Hospital, Portsmouth, UK. E-mail:
| | - Kesavan Kandiah
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
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