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Fernández-Esparrach G, Marín-Gabriel JC. Outcomes of endoscopic submucosal dissection of early gastric cancer neoplasia in the West and change in the absolute indications. Endoscopy 2024; 56:390. [PMID: 38653226 DOI: 10.1055/a-2215-5644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Glòria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - José C Marín-Gabriel
- Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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Papaefthymiou A, Kahaleh M, Lemmers A, Sferrazza S, Barret M, Yamamoto K, Deprez P, Marín-Gabriel JC, Tribonias G, Ouyang H, Barbaro F, Kiosov O, Seewald S, Patil G, Elkholy S, Coumaros D, Vuckovic C, Banks M, Haidry R, Mavrogenis G. Performance of endoscopic submucosal dissection for undifferentiated early gastric cancer: a multicenter retrospective cohort. Endosc Int Open 2023; 11:E673-E678. [PMID: 37744471 PMCID: PMC10513782 DOI: 10.1055/a-2105-1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/31/2023] [Indexed: 09/26/2023] Open
Abstract
Background and study aims Undifferentiated early gastric cancer (UD-EGC) represents an extended indication for endoscopic submucosal dissection (ESD) based on the existing guidelines. This study evaluated the prevalence of UD-EGC recurrence after ESD, and potentially implicated risk factors. Patients and methods Data from 17 centers were collected retrospectively including demographics, endoscopic and pathological findings, and follow-up data from UD-EGC cases treated by ESD. Patients with incomplete resection or advanced disease were excluded. Descriptive statistics quantified variables and calculated the incidence of recurrence. Chi-square test was applied to assess any link between independent variables and relapse; significantly associated variables were inserted to a multivariable regression model. Results Seventy-one patients were eligible, with 2:1 female to male ratio and age of 65.8 ± 11.8 years. Mean lesion size was 33.5 ± 18.8 mm and the most frequent histological subtype was signet ring-cells UGC (2:1). Patients were followed-up every 5.6 ± 3.7 months with a mean surveillance period of 29.3 ± 15.3 months until data collection. Four patients (5.6%) developed local recurrence 8.8 ± 6.5 months post-ESD, with no lymph node or distal metastases been reported. Lesion size was not associated with recurrence ( P = 0.32), in contrast to lymphovascular and perineural invasion which were independently associated with local recurrence ( P = 0.006 and P < 0.001, respectively). Conclusions ESD could be considered as the initial step to manage UD-EGC, providing at least an "entire-lesion" biopsy to guide therapeutic strategy. When histology confirms absence of lymphovascular and perineural invasion, this modality could be therapeutic, providing low recurrence rates.
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Affiliation(s)
- Apostolis Papaefthymiou
- Endoscopy Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Michel Kahaleh
- Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States
| | - Arnaud Lemmers
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Sandro Sferrazza
- Department of Gastroenterology and Digestive Endoscopy, APSS Trento, Trento, Italy
| | - Maximilien Barret
- Gastroenterology and Digestive Oncology, Hopital Cochin, Paris, France
| | - Katsumi Yamamoto
- Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Pierre Deprez
- Cliniques Universitaires St-Luc, Université Catholique de Louvain, Louvain Medical ASBL, Bruxelles, Belgium
| | | | - George Tribonias
- Gastroenterology, General Hospital of Nikaia Peiraia Agios Panteleimon, Athens, Greece
| | - Hong Ouyang
- Endoscopy, The People's Hospital of Linan City, hangzhou, China
| | - Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Oleksandr Kiosov
- University Clinical, Zaporizhzhia State Medical University, Zaporozhye, Ukraine
| | - Stefan Seewald
- Center for Gastroenterology, Hirlanden Clinic Zurich, Zurich, Switzerland
| | | | - Shaimaa Elkholy
- Gastroenterology Division, Internal Medicine Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Dimitri Coumaros
- Gastroenterology Department, Clinique Sainte Barbe, Strasbourg, France
| | - Clemence Vuckovic
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Matthew Banks
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Rehan Haidry
- Gastroenterology, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
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Marín-Gabriel JC, Lora Pablos D, Díaz-Tasende J, Cancelas-Navia P, Rodríguez Muñoz S, Del Pozo-García AJ, Alonso-Riaño M, Rodríguez-Gil Y, Ibarrola-Andrés C, Castellano Tortajada G. Switching from endoscopic submucosal dissection to salvage piecemeal knife-assisted snare resection to remove a lesion: A preoperative risk score from the beginning. Rev Esp Enferm Dig 2019; 110:699-705. [PMID: 30221971 DOI: 10.17235/reed.2018.5608/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS endoscopic submucosal dissection (ESD) in the Western setting remains a challenge. Therefore, other simplified techniques such as knife-assisted snare resection (KAR) have been reported to overcome this issue. METHODS patients who underwent an ESD for the treatment of gastrointestinal neoplasms were included in a retrospective cross-sectional observational study. Factors associated with the end of ESD as a salvage p-KAR were identified and a logistic regression model was developed. RESULTS a total of 136 lesions in 133 patients were analyzed. Operator experience of under 50 cases and the combination of lesion size > 30 mm and colorectal location were independent predictive factors for switching to a salvage p-KAR according to the multivariate logistic regression analysis. We developed a risk scoring system based on these four variables (experience, size, location and the combination of size and location) with a receiver operating characteristic curve of 0.81 (95% CI: 0.74-0.89). The diagnostic accuracy of the score for a cut-off point ≥ 5 had a sensitivity of 0.79 (95% CI: 0.66-0.93) and a specificity of 0.71 (95% CI: 0.61-0.80). CONCLUSION a simple predictive score system that includes four preoperative factors accurately predicts ESD to finish as a p-KAR. A careful selection of cases considering these variables could be useful to achieve better outcomes in the Western setting.
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Affiliation(s)
| | - David Lora Pablos
- Unidad de Investigación Clínica. IMAS12-CIBERESP, Hospital Universitario 12 de Octubre
| | - José Díaz-Tasende
- Servicio de Medicina del Aparato Digestivo, Hospital Universitario 12 de Octubre, España
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Marín-Gabriel JC, Romito R, Guarner-Argente C, Santiago-García J, Rodríguez-Sánchez J, Toyonaga T. Use of electrosurgical units in the endoscopic resection of gastrointestinal tumors. Gastroenterol Hepatol 2019; 42:512-523. [PMID: 31326105 DOI: 10.1016/j.gastrohep.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/31/2019] [Accepted: 04/05/2019] [Indexed: 12/18/2022]
Abstract
Electrosurgical units (ESUs) are indispensable devices in our endoscopy units. However, many endoscopists are not well-trained on their use and their physical bases are usually not properly studied or understood. In addition, comparative data concerning the settings that may be applied in different circumstances are scarce in the medical literature. Given that it is important to be aware of their strengths and risks, we conducted a review of the available information and research on this topic.
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Affiliation(s)
- José C Marín-Gabriel
- Department of Gastroenterology, Endoscopy Unit, High Risk GI Cancer Clinic, Research Institute, 12 de Octubre (i+12), "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain.
| | - Raffaella Romito
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Guarner-Argente
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Santiago-García
- Department of Gastroenterology, Endoscopy Unit, "Puerta de Hierro-Majadahonda" University Hospital, Autonomous University of Madrid (UAM), Majadahonda (Madrid), Spain
| | - Joaquín Rodríguez-Sánchez
- Department of Gastroenterology, Endoscopy Unit, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - Takashi Toyonaga
- Department of Endoscopy, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
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Jover R, Zapater P, Bujanda L, Hernández V, Cubiella J, Pellisé M, Ponce M, Ono A, Lanas A, Seoane A, Marín-Gabriel JC, Chaparro M, Cacho G, Herreros-de-Tejada A, Fernández-Díez S, Peris A, Nicolás-Pérez D, Murcia O, Castells A, Quintero E. Endoscopist characteristics that influence the quality of colonoscopy. Endoscopy 2016; 48:241-7. [PMID: 26845473 DOI: 10.1055/s-0042-100185] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIM Several factors have been shown to be related to colonoscopy quality; however, little is known about the effects of endoscopist factors. This study analyzed the influence of endoscopist-related characteristics on quality indicators for colonoscopy. PATIENTS AND METHODS The study included 48 endoscopists who each performed at least 20 colonoscopies in the colonoscopy arm of a randomized controlled trial comparing fecal immunochemical test vs. colonoscopy in colorectal cancer screening. These endoscopists performed a total of 3838 procedures in the trial. The following were calculated for each endoscopist: adenoma detection rate (ADR), advanced ADR, proximal ADR, distal ADR, and adenoma per colonoscopy rate (APCR). The characteristics of endoscopists were assessed with regard to colonoscopy quality using multivariate regression analysis. Endoscopist characteristics included age, sex, exclusive endoscopy practice, years as a physician, years as a specialist, specialty, total (life-long) number of colonoscopies performed, annual colonoscopy volume, number of hours/week dedicated to endoscopy and number of educational activities in the previous year. RESULTS Factors associated with ADR were age of the endoscopist (odds ratio [OR] 1.11, 95 % confidence interval [CI] 1.01 - 1.21; P = 0.01) and life-long number of colonoscopies (OR 1.06, 95 %CI 1.01 - 1.11; P = 0.01). Only exclusive dedication to endoscopy practice was found to be independently related to proximal ADR (OR 1.71, 95 %CI 1.15 - 2.74; P = 0.001). Life-long number of colonoscopies was independently related to detection of distal adenomas (OR 1.07, 95 %CI 1.01 - 1.13; P = 0.01). None of the analyzed endoscopist characteristics was associated with advanced ADR or APCR. CONCLUSIONS This study found that the experience of the endoscopist and exclusive dedication to endoscopy practice, but not annual colonoscopy volume, were associated with better colonoscopy quality.
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Affiliation(s)
- Rodrigo Jover
- Unidad de Gastroenterología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Pedro Zapater
- Unidad de Farmacología Clínica, Hospital General Universitario de Alicante, Instituto de Investigación sanitaria ISABIAL, Alicante, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Vicent Hernández
- Department of Gastroenterology, Grupo de Investigación en Patología Digestiva, Instituto de Investigación Biomédica, Xerencia de Xestión Integrada de Vigo, Vigo, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra y Vigo, Ourense, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Ponce
- Department of Gastroenterology, Hospital Universitario La Fe, Valencia, Spain
| | - Akiko Ono
- Unidad de Gestión Clínica de Digestivo, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Angel Lanas
- Department of Gastroenterology, Hospital Clínico Lozano Blesa, Universidad de Zaragoza, CIBERehd, Zaragoza, Spain
| | - Agustín Seoane
- Department of Gastroenterology, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
| | | | - María Chaparro
- Department of Gastroenterology, Hospital de la Princesa, CIBERehd, Madrid, Spain
| | - Guillermo Cacho
- Department of Gastroenterology, Fundación Hospital de Alcorcón, Madrid, Spain
| | | | | | - Antonio Peris
- Department of Gastroenterology, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - David Nicolás-Pérez
- Department of Gastroenterology, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Oscar Murcia
- Unidad de Gastroenterología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Enrique Quintero
- Department of Gastroenterology, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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Rodríguez-Soler M, Pérez-Carbonell L, Guarinos C, Zapater P, Castillejo A, Barberá VM, Juárez M, Bessa X, Xicola RM, Clofent J, Bujanda L, Balaguer F, Reñé JM, de-Castro L, Marín-Gabriel JC, Lanas A, Cubiella J, Nicolás-Pérez D, Brea-Fernández A, Castellví-Bel S, Alenda C, Ruiz-Ponte C, Carracedo A, Castells A, Andreu M, Llor X, Soto JL, Payá A, Jover R. Risk of cancer in cases of suspected lynch syndrome without germline mutation. Gastroenterology 2013; 144:926-932.e1; quiz e13-4. [PMID: 23354017 DOI: 10.1053/j.gastro.2013.01.044] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 01/17/2013] [Accepted: 01/22/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Colorectal cancers (CRCs) with microsatellite instability (MSI) and a mismatch repair (MMR) immunohistochemical deficit without hypermethylation of the MLH1 promoter are likely to be caused by Lynch syndrome. Some patients with these cancers have not been found to have pathogenic germline mutations and are considered to have Lynch-like syndrome (LLS). The aim of this study was to determine the risk of cancer in families of patients with LLS. METHODS We studied a population-based cohort of 1705 consecutive patients, performing MSI tests and immunohistochemical analyses of MMR proteins. Patients were diagnosed with Lynch syndrome when they were found to have pathogenic germline mutations. Patients with MSI and loss of MSH2 and/or MSH6 expression, isolated loss of PMS2 or loss of MLH1 without MLH1 promoter hypermethylation, and no pathogenic mutation were considered to have LLS. The clinical characteristics of patients and the age- and sex-adjusted standardized incidence ratios (SIRs) of cancer in families were compared between groups. RESULTS The incidence of CRC was significantly lower in families of patients with LLS than in families with confirmed cases of Lynch syndrome (SIR for Lynch syndrome, 6.04; 95% confidence interval [CI], 3.58-9.54; SIR for LLS, 2.12; 95% CI, 1.16-3.56; P < .001). However, the incidence of CRC was higher in families of patients with LLS than in families with sporadic CRC (SIR for sporadic CRC, 0.48; 95% CI, 0.27-0.79; P < .001). CONCLUSIONS The risk of cancer in families with LLS is lower that of families with Lynch syndrome but higher than that of families with sporadic CRC. These results confirm the need for special screening and surveillance strategies for these patients and their relatives.
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Affiliation(s)
- María Rodríguez-Soler
- Unidad de Gastroenterología, Hospital General Universitario de Alicante, Alicante, Spain
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Jover R, Zapater P, Polanía E, Bujanda L, Lanas A, Hermo JA, Cubiella J, Ono A, González-Méndez Y, Peris A, Pellisé M, Seoane A, Herreros-de-Tejada A, Ponce M, Marín-Gabriel JC, Chaparro M, Cacho G, Fernández-Díez S, Arenas J, Sopeña F, de-Castro L, Vega-Villaamil P, Rodríguez-Soler M, Carballo F, Salas D, Morillas JD, Andreu M, Quintero E, Castells A. Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies. Gastrointest Endosc 2013; 77:381-389.e1. [PMID: 23218945 DOI: 10.1016/j.gie.2012.09.027] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/20/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adenoma detection rate (ADR) has become the most important quality indicator for colonoscopy. OBJECTIVE The aim of this study was to investigate which modifiable factors, directly related to the endoscopic procedure, influenced the ADR in screening colonoscopies. DESIGN Observational, nested study. SETTING Multicenter, randomized, controlled trials. PATIENTS Asymptomatic people aged 50 to 69 years were eligible for a multicenter, randomized, controlled trial designed to compare colonoscopy and fecal immunochemical testing in colorectal cancer screening. A total of 4539 individuals undergoing a direct screening colonoscopy were included in this study. INTERVENTION Colonoscopy. MAIN OUTCOME MEASUREMENTS Bowel cleansing, sedation, withdrawal time in normal colonoscopies, and cecal intubation were analyzed as possible predictors of adenoma detection by using logistic regression analysis, adjusted for age and sex. RESULTS In multivariate analysis, after adjustment for age and sex, factors independently related to the ADR were a mean withdrawal time longer than 8 minutes (odds ratio [OR] 1.51; 95% CI, 1.17-1.96) in normal colonoscopies and split preparation (OR 1.26; 95% CI, 1.01-1.57). For advanced adenomas, only withdrawal time maintained statistical significance in the multivariate analysis. For proximal adenomas, withdrawal time and cecal intubation maintained independent statistical significance, whereas only withdrawal time longer than 8 minutes and a <10-hour period between the end of preparation and colonoscopy showed independent associations for distal adenomas. LIMITATIONS Only endoscopic variables have been analyzed. CONCLUSION Withdrawal time was the only modifiable factor related to the ADR in colorectal cancer screening colonoscopies associated with an increased detection rate of overall, advanced, proximal, and distal adenomas.
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Affiliation(s)
- Rodrigo Jover
- Unidad de Gastroenterología, Hospital General Universitario de Alicante, Alicante, Spain.
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Marín-Gabriel JC, Solís-Herruzo JA. Noninvasive assessment of liver fibrosis. Serum markers and transient elastography (FibroScan). Rev Esp Enferm Dig 2010; 101:787-99. [PMID: 20001156 DOI: 10.4321/s1130-01082009001100006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Both the prognosis and potential treatment of chronic liver disease greatly depend on the progression of liver fibrosis, which is the ultimate outcome of chronic liver damage. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. Histological assessment allows clinicians both to obtain diagnostic information and initiate adequate therapy. However, the technique is not exempt of deleterious effects. Multiple diagnostic tests have been developed for the staging of fibrosis using noninvasive methods, most of them in the setting of chronic hepatitis C. The goal of this paper is to review available data on the staging and assessment of liver fibrosis with two methods: serum markers and transient elastography (FibroScan).
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Affiliation(s)
- J C Marín-Gabriel
- Service of Digestive Diseases, University Hospital 12 de Octubre, Madrid, Spain.
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Rodríguez-Alcalde D, Marín-Gabriel JC, Rodríguez-Muñoz S, de la Cruz Bértolo J, Barreales-Valbuena M, Manzano-Alonso ML, Solís-Herruzo JA. [Tolerability, safety, and efficacy of sodium phosphate preparation for colonoscopy: the role of age]. Rev Esp Enferm Dig 2008; 100:17-23. [PMID: 18358056 DOI: 10.4321/s1130-01082008000100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare subjective tolerance and secondary adverse events to bowel cleansing prior to colonoscopy with polyethylene glycol (PEG) and sodium phosphate (NaP) in adult patients and in those 65 or more years old. MATERIAL AND METHODS Retrospective matched study, choosing 140 patients among all of those who underwent colonoscopy from March 2004 to May 2005. We investigated the presence of the next adverse events during bowel preparation: Fever, low digestive bleeding, abdominal pain, perianal pain, nausea, vomiting, thirst, somnolence, agitation, tremor and convulsions. We considered bad objective tolerance if the patient presented any one of these events. We also asked patients about subjective tolerance to preparation. RESULTS Seventy patients prepared with PEG and seventy with NaP were included (69 women and 71 men, mean age 60.6 +/- 14.8 years). There was no relationship between subjective tolerance or the presence of adverse events and bowel cleansing with any of the products in general population or in elderly patients (p = 0.09 and p = 0.45 in the elderly). However, patients prepared with NaP showed more nausea than those who employed PEG (p < 0.009), overall women of 65 or more years old. There were no severe adverse events in patients prepared with NaP. Elderly showed better tolerance than younger patients, and women worst tolerance than men, irrespective of the lavage preparation employed. Patients prepared with PEG unfinished bowel cleansing more frequently than those with NaP. Cleanliness achieved with NaP was significantly better than that obtained with PEG. CONCLUSIONS Bowel cleansing prior to colonoscopy with NaP is as well tolerated, safe and effective as with PEG, even in elderly healthy patients, although it causes more nausea. Cleanliness with NaP is better than that achieved with PEG.
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Affiliation(s)
- D Rodríguez-Alcalde
- Servicios de Medicina del Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid.
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