Loose Screws: Removal of Foreign Bodies From the Lower Gastrointestinal Tract

While both the American Society for Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE) have released guidelines on the management of ingested foreign bodies in the upper gastrointestinal (GI) tract, neither has addressed indications or techniques for endoscopic removal of foreign bodies in the lower GI tract, perhaps due to the high likelihood of foreign body passage once the foreign body has reached the lower GI tract. We present the case of a 45-year-old woman presenting to the emergency department following the intentional ingestion of multiple screws and nails, complaining of acute abdominal pain and nausea. Imaging revealed four nails in the colon and two adjacent screws in the distal small bowel. In the absence of signs of acute obstruction or bowel perforation, she was admitted for expectant management but subsequently required endoscopic removal of two retained screws in the lower GI tract.

Magnesium Citrate Capsules in Colonoscopy Preparation: A Randomized Controlled Trial

Introduction: Screening colonoscopies are recommended for the detection and prevention of colon cancer. Liquid colonoscopy preparations may be poorly tolerated. We evaluated the adequacy and tolerability of a novel low-cost colonoscopy preparation consisting of magnesium citrate capsules and bisacodyl (MCCB).

Methods: This is a single-center, assessor-blinded, randomized controlled trial of 51 patients undergoing screening colonoscopies, who received a bowel preparation of either 4 liters of GoLYTELY (Braintree Laboratories, Inc., Braintree, MA) or MCCB. The primary outcome was the rate of adequate colon cleanliness, defined as a total score ≥ 6 on the Boston Bowel Preparation Scale and no colon segment with a score of zero. The secondary outcome was patient satisfaction, assessed by a validated questionnaire.

Results: A total of 100% of patients in both arms achieved adequate colon cleanliness, and the magnesium citrate arm had superior patient satisfaction (mean satisfaction score: 54.8 vs. 172.8; p < 0.001).

Conclusions: A pill-based colonoscopy preparation of MCCB may be a low-cost option for patients reluctant to consume a liquid preparation.

Polyethylene glycol plus bisacodyl: A safe, cheap, and effective regimen for colonoscopy in the South Asian patients

Background and Aim

Data regarding the comparison of colonoscopic preparation regimens are still variable. We aimed to assess the adequacy and tolerability of two bowel preparation regimens for afternoon colonoscopy.

Methods

In a randomized, investigator‐blinded trial, two preparation regimens [4‐L split‐dose polyethylene glycol‐electrolytes (PEG‐ELS) and 2‐L PEG‐ELS plus bisacodyl) were compared in terms of bowel cleansing efficacy and adverse effects.

Results

The mean (±SD) age (years) of the 4‐L split‐dose PEG‐ELS group (N = 147) and the 2‐L PEG‐ELS plus bisacodyl (N = 155) were 44.09 (±15.62) (M:F : 2:1) and 44.12 years (±15.61) (M:F : 1.7:1), respectively. Percentage of patients with excellent and good preparation was higher in the 4‐L split‐dose PEG‐ELS regimen compared with the 2‐L PEG‐ELS plus bisacodyl regimen (22.44 vs 17.41 and 44.21% vs 36.12%). Percentage of patients with fair and poor preparation was lower in 4‐L split‐dose PEG‐ELS regimen compared with the 2‐L PEG‐ELS plus bisacodyl regimen (21.08% vs 27.74% and 12.24% vs 18.70%). In comparison with the 2‐L PEG‐ELS plus bisacodyl group, the incidences of abdominal pain (11% vs 15%), bloating (9% vs 12.24%), nausea/vomiting (8.38% vs 9.52%), and sleep disturbance (11% vs 12%) were slightly more common in the 4‐L split‐dose PEG‐ELS group. There were no statistically significant differences between the two regimens with regard to bowel cleansing efficacy and adverse events.

Conclusions

The 2‐L PEG‐ELS plus bisacodyl (10 mg) preparation is as efficacious as the 4‐L split‐dose PEG‐ELS regimen for afternoon colonoscopy. Optimal preparation for colonoscopy can be achieved with the 2‐L PEG‐ELS plus bisacodyl regimen with slightly fewer adverse events and lower cost compared to the 4‐L split‐dose PEG‐ELS regimen.

A Smartphone App for Improvement of Colonoscopy Preparation (ColoprAPP): Development and Feasibility Study

Background

Optimal bowel preparation is one of the major cornerstones for quality of colonoscopy. But poor bowel preparation still occurs in 10% to 25% of all patients. To optimize patient guidance, we developed a new smartphone app (ColoprAPP) for Android smartphones which guides and accompanies the patient starting 4 days before colonoscopy throughout the whole colonoscopy preparation procedure.

Objective

The objective of this study was to assess the function of a newly developed smartphone app for supporting colonoscopy preparation.

Methods

We carried out a prospective feasibility study including 25 patients undergoing outpatient colonoscopy at our hospital. As a control, we retrieved the data of 25 patients undergoing outpatient colonoscopy matching in age, sex, and indication for colonoscopy from our colonoscopy database. Patients were asked to download the smartphone app, ColoprAPP, in addition to being given the regular colonoscopy preparation leaflet. All colonoscopies were performed in the morning after using a split-dose preparation containing a polyethlene glycol–based purgative. The study was designed to test feasibility of the prototype, evaluate grade of bowel cleanliness (Boston bowel preparation scale [BBPS]), and assess patient satisfaction with the app.

Results

The smartphone app use was feasible in all patients. BBPS count as a marker for grade of bowel preparation was significantly higher in the smartphone app–supported group (mean 8.1 [SD 0.3] vs 7.1 [SD 0.4], P=.02). Left (mean 2.8 [SD 0.1] vs 2.4 [SD 0.11], P=.02) and transverse colon (mean 2.8 [SD 0.07] vs 2.4 [SD 0.11], P<.001) revealed significantly higher BBPS counts in the smartphone app–supported group than in controls. Patient satisfaction with a smartphone app–supported colonoscopy preparation was high with an average numeric rating scale score for usefulness of 8.2 (visual analog scale 1-10).

Conclusions

A novel developed smartphone app for reinforced education of bowel cleansing was feasible and led to high BBPS scores and patient satisfaction.

Trial registration

ClinicalTrials.gov NCT02512328; https://clinicaltrials.gov/ct2/show/NCT02512328 (Archived by WebCite at http://www.webcitation.org/6sz3Kk26z)

Comparison of claims data on hospitalization rates and repeat procedures in patients receiving a bowel preparation prior to colonoscopy

OBJECTIVES

To evaluate outcomes of colorectal screening using sodium picosulfate and magnesium citrate compared with other prescription bowel-preparation agents. Primary endpoints were rates of procedure-associated hospitalizations, diagnosis at hospitalization, and rates of early repeat screenings.

METHODS

This retrospective cohort study identified patients using the Truven Health Analytics MarketScan databases, which contain fully adjudicated, de-identified, medical- and prescription-drug claims, as well as demographic and enrollment information for individuals with commercial, Medicaid, and Medicare supplemental insurance coverage. Patients who had a colonoscopy or sigmoidoscopy over a 3-year period were identified using International Classification of Diseases Clinical Modification procedure codes, recorded on claims from physicians and facilities. First, screening colonoscopy was identified for each patient, and the study was limited to those patients who could be observed for ≥6 months before and 3 months after the screening procedure. Total number of hospitalizations and rates of early repeat screenings were evaluated for all patients who received sodium picosulfate and magnesium citrate and compared with those who received other bowel-preparation agents. Individual prescription medications that could affect the outcome of the cleansing agent were identified; further evaluations were made to establish whether patients had comorbid conditions, such as chronic kidney disease, cardiovascular disease, or psychiatric illness. Statistical methods included descriptive statistics, two-tailed t-tests, and multivariate logistic regression.

RESULTS

A total of 566,628 procedures were identified in the MarketScan databases and included in the study. Sodium picosulfate and magnesium citrate performed well in terms of safety outcomes, with no hospitalizations due to diagnosis of hyponatremia, dehydration, or other fluid disorders in the 10 days after procedure. Early repeat rates among sodium picosulfate and magnesium citrate patients were comparable with rates observed for all other cleansing agents.

CONCLUSION

Outcomes of colorectal screening using sodium picosulfate and magnesium citrate were not significantly different compared with other prescription bowel-preparation agents.

LONGER CECUM INSERTION TIME AND MORE INADEQUATE COLONIC PREPARATION IN PATIENTS WITH ACROMEGALY: IS A DIFFERENT COLONOSCOPY PREPARATION NEEDED?

Purpose

To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention.

Methods

Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results.

Results

Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07).

Conclusion

Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.

Development and Testing of an Automated 4-Day Text Messaging Guidance as an Aid for Improving Colonoscopy Preparation

Background

In gastroenterology a sufficient colon cleansing improves adenoma detection rate and prevents the need for preterm repeat colonoscopies due to invalid preparation. It has been shown that patient education is of major importance for improvement of colon cleansing.

Objective

Objective of this study was to assess the function of an automated text messaging (short message service, SMS)–supported colonoscopy preparation starting 4 days before colonoscopy appointment.

Methods

After preevaluation to assess mobile phone usage in the patient population for relevance of this approach, a Web-based, automated SMS text messaging system was developed, following which a single-center feasibility study at a tertiary care center was performed. Patients scheduled for outpatient colonoscopy were invited to participate. Patients enrolled in the study group received automated information about dietary recommendations and bowel cleansing during colonoscopy preparation. Data of outpatient colonoscopies with regular preparation procedure were used for pair matching and served as control. Primary end point was feasibility of SMS text messaging support in colonoscopy preparation assessed as stable and satisfactory function of the system. Secondary end points were quality of bowel preparation according to the Boston Bowel Preparation Scale (BBPS) and patient satisfaction with SMS text messaging–provided information assessed by a questionnaire.

Results

Web-based SMS text messaging–supported colonoscopy preparation was successful and feasible in 19 of 20 patients. Mean (standard error of the mean, SEM) total BBPS score was slightly higher in the SMS group than in the control group (7.3, SEM 0.3 vs 6.4, SEM 0.2) and for each colonic region (left, transverse, and right colon). Patient satisfaction regarding SMS text messaging–based information was high.

Conclusions

Using SMS for colonoscopy preparation with 4 days’ guidance including dietary recommendation is a new approach to improve colonoscopy preparation. Quality of colonoscopy preparation was sufficient and patients were highly satisfied with the system during colonoscopy preparation.