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Jacobson BC, Anderson JC, Burke CA, Dominitz JA, Gross SA, May FP, Patel SG, Shaukat A, Robertson DJ. Optimizing bowel preparation quality for colonoscopy: consensus recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2025; 101:702-732. [PMID: 40047767 DOI: 10.1016/j.gie.2025.02.010] [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: 12/30/2024] [Indexed: 04/07/2025]
Abstract
This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.
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Affiliation(s)
- Brian C Jacobson
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph C Anderson
- VA Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jason A Dominitz
- Gastroenterology Section, VA Puget Sound Health Care System, Seattle, Washington, USA; Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | | | - Folasade P May
- Department of Medicine, Division of Gastroenterology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA; Vatche and Tamar Manoukian Division of Digestive Diseases and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Swati G Patel
- University of Colorado Anschutz Medical Center, Aurora, Colorado, USA; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Aasma Shaukat
- GI Section, Minneapolis VA Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Jacobson BC, Anderson JC, Burke CA, Dominitz JA, Gross SA, May FP, Patel SG, Shaukat A, Robertson DJ. Optimizing Bowel Preparation Quality for Colonoscopy: Consensus Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2025; 120:738-764. [PMID: 40035345 DOI: 10.14309/ajg.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Indexed: 03/05/2025]
Abstract
This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.
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Affiliation(s)
- Brian C Jacobson
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph C Anderson
- VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jason A Dominitz
- Gastroenterology Section, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | | | - Folasade P May
- Department of Medicine, Division of Gastroenterology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Swati G Patel
- University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Aasma Shaukat
- GI Section, Minneapolis VA Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Jacobson BC, Anderson JC, Burke CA, Dominitz JA, Gross SA, May FP, Patel SG, Shaukat A, Robertson DJ. Optimizing Bowel Preparation Quality for Colonoscopy: Consensus Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2025; 168:798-829. [PMID: 40047732 DOI: 10.1053/j.gastro.2025.02.002] [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] [Indexed: 03/24/2025]
Abstract
This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.
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Affiliation(s)
- Brian C Jacobson
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Joseph C Anderson
- VA Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; University of Connecticut School of Medicine, Farmington, Connecticut
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Jason A Dominitz
- Gastroenterology Section, VA Puget Sound Health Care System, Seattle, Washington; Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington
| | | | - Folasade P May
- Department of Medicine, Division of Gastroenterology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Swati G Patel
- University of Colorado Anschutz Medical Center, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Aasma Shaukat
- GI Section, Minneapolis VA Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Li J, Chen JP, Lai CH, Fu L, Ji Y. Efficacy of water infusion combined with defoamers in colonoscopy. World J Gastrointest Surg 2025; 17:99784. [PMID: 40162402 PMCID: PMC11948134 DOI: 10.4240/wjgs.v17.i3.99784] [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: 11/21/2024] [Revised: 12/25/2024] [Accepted: 01/15/2025] [Indexed: 02/24/2025] Open
Abstract
BACKGROUND Currently, colonoscopy still needs continuous optimization and exploration of novel alternative approaches to enhance the experience of patients during colonoscopy. AIM To analyze the efficacy of water infusion combined with defoamers in colonoscopy. METHODS This study included 97 patients undergoing colonoscopy from January 2024 to June 2024. The participants were categorized into two groups, namely, the control group (n = 47), who underwent conventional colonoscopy, and the experimental group (n = 50), who received colonoscopy using water injection combined with defoamers. A comparative analysis was then conducted on the disease detection rate (colonic polyps, colonorrhagia, colonic ulcers, colonic mucosal lesions, and others), colonoscopy duration, abdominal pain [visual analog scale (VAS)], Boston bowel preparation scale (BBPS), self-rating anxiety scale (SAS), bowel preparation comfort, complications (intestinal perforation, bleeding, nausea and vomiting, abdominal pain, and abdominal distension), and patient satisfaction. RESULTS The experimental group demonstrated a significantly higher total disease detection rate, BBPS scores, and patient satisfaction compared with the control group. Further, the research group exhibited shorter colonoscopy duration, lower VAS and SAS scores and total complication rate, and better patient comfort and satisfaction. CONCLUSION These results indicate that the combination of water injection and defoamers exhibited an overall better therapeutic effect than conventional colonoscopy, mainly reflected in higher disease detection rate, faster examination efficiency, lower abdominal pain, anxiety, and complication incidences, and significantly better bowel preparation, comfort, and patient satisfaction.
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Affiliation(s)
- Jian Li
- Department of Gastroenterology, Nanhai Family Practice Hospital (Nanhai Guicheng Hospital), Foshan 528000, Guangdong Province, China
| | - Jun-Ping Chen
- Department of Internal Medicine, Nanhai Family Practice Hospital (Nanhai Guicheng Hospital), Foshan 528000, Guangdong Province, China
| | - Chun-Han Lai
- Department of Internal Medicine, Nanhai Family Practice Hospital (Nanhai Guicheng Hospital), Foshan 528000, Guangdong Province, China
| | - Lian Fu
- Department of Gastroenterology, Nanhai Family Practice Hospital (Nanhai Guicheng Hospital), Foshan 528000, Guangdong Province, China
| | - Yong Ji
- Department of Gastrointestinal Surgery, The First People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
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Maida M, Marasco G, Fuccio L, Vitello A, Mocciaro F, Amata M, Fabbri A, Di Mitri R, Vassallo R, Ramai D, Hassan C, Repici A, Facciorusso A. Comparative efficacy of different bowel preparations for colonoscopy: A network meta-analysis. Dig Liver Dis 2025; 57:688-696. [PMID: 39676010 DOI: 10.1016/j.dld.2024.11.019] [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: 08/29/2024] [Revised: 11/24/2024] [Accepted: 11/26/2024] [Indexed: 12/17/2024]
Abstract
BACKGROUND AND AIMS The quality of a colonoscopy is heavily reliant on the effectiveness of bowel cleansing. Various cleansing solutions are currently available, but their comparative efficacy remains uncertain. This systematic review and network meta-analysis aims to compare the performance of different bowel preparations for colonoscopy. METHODS MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing the efficacy of different bowel preparations. The primary outcome was cleansing success (CS), and the secondary outcome was adenoma detection rate (ADR). RESULTS On network meta-analysis for CS (22 RCTs, 7179 patients, 14 bowel preparations), 2 L PEG + simethicone (RR = 1.25 [95 %CI = 1.13-1.37]), 2 L PEG + lactulose (RR = 1.22 [95 %CI = 1.10-1.38]) and 1 L PEG + ascorbate (ASC) (RR = 1.03 [95 %CI = 1.01-1.06]) were significantly superior to 2 L PEG + ASC. Overall, 2 L PEG + lactulose resulted as the best product (SUCRA 0.94), followed by 2 L PEG + simethicone (SUCRA 0.93). On network meta-analysis for ADR (17 RCTs, 6639 patients, 11 bowel preparations), only 2 L PEG + simethicone (RR = 1.60 [95 %CI = 1.05-2.43]) resulted significantly superior to 2 L PEG + ASC. CONCLUSIONS 2 L PEG + simethicone, 2 L PEG + lactulose, and 1 L PEG + ASC seemed to provide high rates of CS, albeit only 2 L PEG + simethicone was associated with significantly higher ADR. Consequently, these products should be preferred for bowel preparation of colonoscopy. Further randomized studies with adequate sample sizes are needed for a more accurate comparison of these products on ADR.
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Affiliation(s)
- M Maida
- Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy; Gastroenterology Unit, Umberto I Hospital, Enna, Italy.
| | - G Marasco
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - L Fuccio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A Vitello
- Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy; Gastroenterology Unit, Umberto I Hospital, Enna, Italy
| | - F Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - M Amata
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - A Fabbri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - R Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - R Vassallo
- Gastroenterology Unit, Buccheri la Ferla Hospital, Palermo, Italy
| | - D Ramai
- Division of Gastroenterology, Hepatology, and Nutrition, University of Utah Health, Salt Lake City, UT, USA
| | - C Hassan
- Endoscopy Unit, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - A Repici
- Endoscopy Unit, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - A Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
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Shu S, Zhang C, Liu L, Shan J, Xiang T, Shu T, Sun X. Terminal ileal intubation is not necessary in routine colonoscopy: data from a large-scale retrospective study. BMC Gastroenterol 2024; 24:432. [PMID: 39592930 PMCID: PMC11600910 DOI: 10.1186/s12876-024-03521-3] [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: 08/07/2024] [Accepted: 11/15/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Terminal ileal intubation (TII) demonstrates a complete colonoscopy, but whether it should be performed in routine colonoscopies remains uncertain. We aimed to explore the diagnostic yield of TII in routine colonoscopy and investigate the association of TII and the detection of lesion. METHODS We conducted a retrospective study included patients who underwent colonoscopy with cecal intubation at our endoscopic center between November 1 2022 and July 31 2023. Macroscopic and histologic findings of terminal ileum were recorded. We used propensity score matching to adjust for differences between groups and further analyzed the difference of polyp detection rate (PDR), adenoma detection rate (ADR), sessile serrated lesion detection rate (SSDR) and lesion detection rate of right-sided colon, cecum and ascending colon between patients underwent TII or not. RESULTS There were 13,372 patients with cecal intubation colonoscopy, including 7599 (56.8%) with TII and 5773 (43.2%) without TII. Abnormal endoscopic findings were observed in 150 of 7599 unselected individuals and only 7 of these cases were regarded as pathologically significant. Likewise, abnormal endoscopic findings were found in 62 of 3502 asymptomatic individuals with 54 nonspecific ileitis determined by histopathology. After PSM, there were no significant differences in PDR (52.0% vs. 52.3%, P = 0.761), ADR (30.9% vs. 32.2%, P = 0.208), SSDR (1.6% vs. 1.5%, P = 0.541), right-sided lesion detection rate (16.9% vs. 16.8%, P = 0.908), lesion detection rate of cecum (4.9% vs. 4.7%, P = 0.613) and ascending colon (13.5% vs. 13.2%, P = 0.656) between the two groups. CONCLUSION TII was not necessary in routine colonoscopy, owing to the limited diagnostic value and lack of superiority on lesion detection.
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Affiliation(s)
- Shunqing Shu
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Chen Zhang
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Liu Liu
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jing Shan
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Tong Xiang
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Tao Shu
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xiaobin Sun
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China.
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LEONARDI G, VINTI M, CIPRANDI G. Polyethylene glycol 3350 plus simethicone for bowel preparation: a real-world experience. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2024; 183. [DOI: 10.23736/s0393-3660.24.05529-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
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João M, Areia M, Alves S, Elvas L, Brito D, Saraiva S, Cadime AT. The Effect of Oral Simethicone in a Bowel Preparation in a Colorectal Cancer Screening Colonoscopy Setting: A Randomized Controlled Trial. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:116-123. [PMID: 38572443 PMCID: PMC10987070 DOI: 10.1159/000530866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2024]
Abstract
Introduction Current guidelines suggest adding oral simethicone to bowel preparation for colonoscopy. However, its effect on key quality indicators for screening colonoscopy remains unclear. The primary aim was to assess the rate of adequate bowel preparation in split-dose high-volume polyethylene glycol (PEG), with or without simethicone. Methods This is an endoscopist-blinded, randomized controlled trial, including patients scheduled for colonoscopy after a positive faecal immunochemical test. Patients were randomly assigned to 4 L of PEG split dose (PEG) or 4 L of PEG split dose plus 500 mg oral simethicone (PEG + simethicone). The Boston Bowel Preparation Scale (BBPS) score, the preparation quality regarding bubbles using the Colon Endoscopic Bubble Scale (CEBuS), ADR, CIR, and the intraprocedural use of simethicone were recorded. Results We included 191 and 197 patients in the PEG + simethicone group and the PEG group, respectively. When comparing the PEG + simethicone group versus the PEG group, no significant differences in adequate bowel preparation rates (97% vs. 93%; p = 0.11) were found. However, the bubble scale score was significantly lower in the PEG + simethicone group (0 [0] versus 2 [5], p < 0.01), as well as intraprocedural use of simethicone (7% vs. 37%; p < 0.01). ADR (62% vs. 61%; p = 0.86) and CIR (98% vs. 96%, p = 0.14) did not differ between both groups. Conclusion Adding oral simethicone to a split-bowel preparation resulted in a lower incidence of bubbles and a lower intraprocedural use of simethicone but no further improvement on the preparation quality or ADR.
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Affiliation(s)
- Mafalda João
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Miguel Areia
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Susana Alves
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Luís Elvas
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Daniel Brito
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Sandra Saraiva
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Ana Teresa Cadime
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
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Gao JX, Liu HF. [Recent research on the application of defoamers in children undergoing digestive endoscopy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:541-545. [PMID: 37272183 DOI: 10.7499/j.issn.1008-8830.2301074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Endoscopy is a common tool for the diagnosis and treatment of gastrointestinal disorders in children. The presence of bubbles in the gastrointestinal tract is one of the important factors affecting the clarity of endoscopic visual field, and the application of defoamers can significantly reduce bubbles in the gastrointestinal tract, improve the quality of gastrointestinal preparation, and further increase disease detection rate. Various studies have been conducted on gastrointestinal preparation before endoscopy in children, but there still lacks a uniform protocol for the application of defoamers. This article summarizes the use of defoamers in children before digestive endoscopy and related research advances and points out that existing studies on defoamers have a small sample size and that there are still controversies over the selection and timing of administration, so as to provide a reference for in-depth research on defoamers in the future.
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Affiliation(s)
- Jie-Xia Gao
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Hai-Feng Liu
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
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10
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Jung W, Oh GM, Kim JH, Choi YJ, Son MY, Jung K, Kim SE, Moon W, Park MI, Park SJ. When should patients take simethicone orally before colonoscopy for avoiding bubbles: A single-blind, randomized controlled study. Medicine (Baltimore) 2023; 102:e33728. [PMID: 37171339 PMCID: PMC10174409 DOI: 10.1097/md.0000000000033728] [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: 10/27/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Many studies have reported the use of simethicone before colonoscopy removes bubbles. However, guidelines weakly recommend simethicone administration before colonoscopy. The present study aimed to confirm the advantages of taking simethicone and determine the appropriate time for taking simethicone. METHODS We randomly assigned patients to the following 5 groups according to the administration time: 4 groups were divided based on 2 parameters (the day before and on the day of colonoscopy and before and after bowel cleansing) and the remaining group was the control group. We compared bubble score (BS), number of simethicone solution irrigations when visually obscured, satisfaction score of the endoscopist, insertion time. RESULTS A total of 204 patients were included in the study. There was a difference in BS according to the timing of simethicone administration (P < .001). The group taking simethicone on the day of the test had a better BS than the group taking simethicone the day before (P < .001). The group taking simethicone on the previous day had a better BS than the control group (P = .001). In the group of taking simethicone on the examination day, the number of irrigations was lower, and satisfaction with the inspector was higher than group of taking simethicone on previous day and control group (both P < .001). The insertion time showed a non-significantly decreasing trend (P = .417). CONCLUSION Administering simethicone reduced bubbles and facilitated effective colonoscopy, especially when administrating it on the day of examination. It needs to be administered on the day of the examination regardless of bowel preparation.
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Affiliation(s)
- Woohyuk Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Gyu Man Oh
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Youn Jung Choi
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Min Young Son
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Sun M, Yang G, Wang Y. Cleaning effect and tolerance of 16 bowel preparation regimens on adult patients before colonoscopy: a network meta-analysis. Int J Colorectal Dis 2023; 38:69. [PMID: 36905434 DOI: 10.1007/s00384-023-04355-3] [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] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Colonoscopy is the gold standard for the diagnosis of colorectal cancer (CRC). Before a colonoscopy, an adequate bowel preparation (BP) is required. Currently, more novel regimens with different effects have been proposed and used successively. This network meta-analysis aims to compare the cleaning effects and patients' tolerability of several BP regimens. METHODS We performed a network meta-analysis of randomized controlled trials including sixteen kinds of BP regimens. We searched PubMed, Cochrane Library, Embase, and Web of Science databases. The outcomes of this study were bowel cleansing effect and tolerance. RESULTS We included a total of 40 articles with 13,064 patients. For the primary outcomes, polyethylene glycol (PEG) + ascorbic acid (Asc) + simethicone (Sim) (OR, 14.27, 95%CrI, 2.68-127.87) regimen is ranked first in Boston Bowel Preparation Scale (BBPS). PEG + Sim (OR, 2.0, 95%CrI 0.64-6.4) regimen is ranked first in Ottawa Bowel Preparation Scale (OBPS), but without significant differences. For the secondary outcomes, PEG + Sodium Picosulfate/Magnesium Citrate (SP/MC) (OR, 4.88e + 11, 95%CrI, 39.56-1.82e + 35) regimen is the best in cecal intubation rate(CIR). PEG + Sim (OR,1.5, 95%CrI, 1.0-2.2) regimen is ranked first in adenoma detection rate(ADR). Senna (OR, 3.23, 95%CrI, 1.04-9.97) and SP/MC (OR, 249.91, 95%CrI, 78.49-958.19) regimens are ranked first in abdominal pain and willingness to repeat, respectively. There is no significant difference in cecal intubation time (CIT), polyp detection rate (PDR), nausea, vomiting, and abdominal bloat. CONCLUSION PEG + Asc + Sim regimen is more effective at cleaning the bowel. PEG + SP/MC will be helpful to increase CIR. For ADR, PEG + Sim regimen will be more helpful. In addition, PEG + Asc + Sim is the least likely to cause abdominal bloat, while Senna regimen is more likely to cause abdominal pain. Patients prefer to re-use the SP/MC regimen for bowel preparation.
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Affiliation(s)
- Ming Sun
- College of Life Sciences and Biopharmaceuticals, Shenyang Pharmaceutical University, Shenyang, China
- Pharmacy Department of Chinese PLA No. 463 Hospital, Shenyang, China
| | - Guangzhao Yang
- Department of Outpatient, General Hospital of Northern Theater Command, Shenyang, China
| | - Yu Wang
- College of Life Sciences and Biopharmaceuticals, Shenyang Pharmaceutical University, Shenyang, China.
- Pharmacy Department of Chinese PLA No. 463 Hospital, Shenyang, China.
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12
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Zhu XW, Yan J, Miao L, He YL, Wang HP, Li X. Safety and efficacy comparison of polyethylene glycol, hemp seed oil, and 5% sugar brine for bowel preparation in older patients: study protocol for a randomized controlled trial. Trials 2023; 24:168. [PMID: 36879331 PMCID: PMC9990200 DOI: 10.1186/s13063-022-07059-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/30/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The incidence of colorectal cancer among the middle-aged and elderly is gradually increasing in China. Colonoscopy is an effective method for the early diagnosis of colorectal cancer, and bowel preparation is one of many important factors affecting colonoscopy. Although there are many studies on intestinal cleansers, the results are not ideal. There is evidence that hemp seed oil has certain potential effects in intestinal cleansing, but prospective studies on this topic are still lacking. METHODS This is a randomized, double-blind, single-center clinical study. We randomly assigned 690 participants to groups each administered 3 L of polyethylene glycol (PEG), 30 mL of hemp seed oil and 2 L of PEG, or 30 mL of hempseed oil, 2 L of PEG, and 1000 mL of 5% sugar brine. The Boston Bowel Preparation Scale was considered the primary outcome measure. We evaluated the interval between consumption of bowel preparation and first bowel movement. Secondary indicators included the time of cecal intubation, detection rate of polyps and adenomas, willingness to repeat the same bowel preparation, whether the protocol was tolerated, and whether there were adverse reactions during bowel preparation and were evaluated after counting the total number of bowel movements. DISCUSSION This study aimed to test the hypothesis that hemp seed oil (30 mL) increases the quality of bowel preparation and reduces the amount of PEG. Previously, we found that its combination with 5% sugar brine can reduce the occurrence of adverse reactions. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200057626. Prospectively registered on March 15, 2022.
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Affiliation(s)
- Xing Wang Zhu
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Jun Yan
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, China.,Key Laboratory of Biological Therapy and Regenerative Medicine of Gansu Province, Lanzhou, 730000, China
| | - Long Miao
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Ying Li He
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Hai Ping Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, China.,Key Laboratory of Biological Therapy and Regenerative Medicine of Gansu Province, Lanzhou, 730000, China
| | - Xun Li
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China. .,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, China. .,Key Laboratory of Biological Therapy and Regenerative Medicine of Gansu Province, Lanzhou, 730000, China.
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Speer T, Vickery K, Alfa M, Sáenz R. Minimizing the Risks of Simethicone in Endoscope Reprocessing. J Clin Gastroenterol 2023; 57:153-158. [PMID: 36508253 DOI: 10.1097/mcg.0000000000001807] [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] [Received: 03/01/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
This statement was written under the auspices of the World Gastroenterology Organization's Guidelines Committee. The authors are members of the Review Team of the WGO Endoscope Disinfection Guideline and have experience in endoscopy, endoscope reprocessing, and microbiology, including biofilms. During the preparation of the WGO Update on Endoscope Disinfection Guidelines, concerns about simethicone on endoscope channel surfaces compromising cleaning and disinfection were raised. Publications on simethicone, including modes of delivery, effectiveness, and risks, have been reviewed. The paper was written as a companion to the new guidelines with a focus on minimizing the risks of simethicone in endoscope reprocessing.
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Affiliation(s)
- Tony Speer
- The Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Roque Sáenz
- Facultad de Medicina, Universidad del Desarrollo, Clinica Alemana de Santiago, Santiago, Chile
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14
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Zhao M, Xu Y, Zhu H, Chen J, Sun W, Yang D, Peng H. A prospective cohort study of the relationship between the withdrawal time and the detection rate of colorectal adenoma. Scand J Gastroenterol 2022; 57:1131-1137. [PMID: 35465795 DOI: 10.1080/00365521.2022.2064722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The effect of colonoscopy withdrawal time (WT) beyond 6 min on colorectal adenoma detection rate (ADR) is unclear. We focused on the relationship between WT and ADR. MATERIALS AND METHODS This study was a prospective observational study involving 437 patients who underwent colonoscopy at Tongren Hospital in Shanghai from 1 July 2020 to 31 August 2020. Patients were divided into two groups according to whether the WT was >6 min. Age, sex, body mass index (BMI), defoaming rate score, Boston bowel preparation scale (BBPS), primary colonoscopy, hypertension, diabetes mellitus, dietary preparation 1 day before the examination, and abdominal surgery history factors were analysed by univariate and multivariable logistic regression to explore the odds ratios (ORs) of ADR in two WT groups. Restricted cubic spline regression was used to further analyze the relationship between WT and the ORs of adenoma detection. RESULTS The ADR among 437 patients was 17.16% (75/437). Multivariable regression analysis showed that in the group with WT >6 min, patients aged ≥50 years old and male could have an increased risk of adenoma detection (OR 5.80, 95% CI 2.32-14.47; p < .001; OR 2.30, 95% CI 1.19-4.43; p = .013). The cubic spline curve showed that the ADR increased with time for WT of 6-8 min, and the highest ADR was achieved when the WT was controlled at 8 min (WT = 5.997, OR = 0.997; WT = 8.240 min, OR = 3.092). CONCLUSION The highest ADR was achieved when the WT of colonoscopy was controlled at 8 min.
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Affiliation(s)
- Min Zhao
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Xu
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haijing Zhu
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiaying Chen
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weijie Sun
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Daming Yang
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haixia Peng
- Digestive Endoscopy Center, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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15
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Kim JH, Park YE, Kim TO, Park J, Oh GM, Moon W, Park SJ. Comparison of the efficacy and safety between oral sulfate tablet and polyethylene glycol for bowel preparation before colonoscopy according to age. Medicine (Baltimore) 2022; 101:e29884. [PMID: 35801801 PMCID: PMC9259131 DOI: 10.1097/md.0000000000029884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recently, a novel oral sulfate tablet (OST) has been introduced for bowel preparation before colonoscopy. However, whether elderly patients can take OST is not yet clear, as OST consists of 28 tablets. We aimed to compare the efficacy and safety of OST and polyethylene glycol (PEG) for bowel preparation for colonoscopy according to age. METHODS We randomly divided subjects into an OST group and a PEG group and compared Boston Bowel Preparation Score (BBPS), bubble score, patient compliance and satisfaction, and safety between the 2 groups according to age (under 65 years of age vs 65 years of age and older). RESULTS Among the 179 participants, 61 were 65 years of age and older. The BBPS and bubble score of the OST group were better than that of the PEG group, regardless of age. The satisfaction of the OST group was better than that of the PEG group, regardless of age. The compliance was not different between the 2 groups; however, the OST group under 65 years of age had a higher rate of completing the dose within 2 hours compared with the PEG group under 65 years of age. Adverse events including abdominal distension, abdominal pain, nausea, or vomiting were not different between the 2 groups. CONCLUSION The use of OST for bowel preparation before colonoscopy is as effective and safe as PEG, and these results were consistent in elderly people 65 years of age and older.
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Affiliation(s)
- Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yong Eun Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jongha Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Gyu Man Oh
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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16
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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: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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17
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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: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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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: 17] [Impact Index Per Article: 4.3] [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: 11/24/2021] [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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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: 8] [Impact Index Per Article: 2.0] [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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20
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Liu X, Yuan M, Li Z, Fei S, Zhao G. The Efficacy of Simethicone With Polyethylene Glycol for Bowel Preparation: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2021; 55:e46-e55. [PMID: 34085989 PMCID: PMC8183475 DOI: 10.1097/mcg.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Simethicone (SIM) is a commonly used antifoaming agent in the clinic. However, it has not been clarified whether SIM can improve the quality of intestinal preparation and the detection rates of adenomas (ADR) and polyps (PDR). This systematic review and meta-analysis were carried out to mainly evaluate the effect of SIM in bowel preparation for colonoscopy. MATERIALS AND METHODS An electronic and a manual search of the literature for studies was conducted in PubMed, EMBASE, and Web of Science in all published data before February 1, 2020. The primary outcomes were the quality of bowel preparation and the ADR and PDR. All the data were calculated using a pooled estimate of risk ratio with 95% confidence intervals, and a random-effect model was used for the calculation. RESULTS Eighteen randomized controlled trials with 7187 patients were included in this meta-analysis. Polyethylene glycol (PEG) with SIM improved colon cleansing (P<0.00001), PDR (P=0.006) and the detection rate of lesions in the right colon (P<0.00001) when compared with PEG alone. There was no difference in the ADR (P=0.68), withdrawal time (P=0.06), cecal intubation rate (P=0.98), and cecal intubation time (P=0.65) between 2 groups. The rate of abdominal bloating rate was higher in the PEG group, but there was no significant difference in vomiting (P=0.65), and abdominal pain (P=0.25). CONCLUSIONS SIM improves the quality of bowel cleanliness and PDR but not ADR. Besides, SIM improves the detection rate of lesions in the right colon and decreased abdominal bloating, but do not affect vomiting and abdominal pain or cramping.
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Affiliation(s)
- Xin Liu
- Departments of Gastroenterology
| | | | - Zhen Li
- Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou
| | | | - Guodong Zhao
- Zhejiang University Kunshan Biotechnology Laboratory, Zhejiang University Kunshan Innovation Institute, Kunshan, Jiangsu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
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21
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Hsieh YH, Tang CP, Tseng CW, Lin TL, Leung FW. Computer-Aided Detection False Positives in Colonoscopy. Diagnostics (Basel) 2021; 11:1113. [PMID: 34207226 PMCID: PMC8235696 DOI: 10.3390/diagnostics11061113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
Randomized control trials and meta-analyses comparing colonoscopies with and without computer-aided detection (CADe) assistance showed significant increases in adenoma detection rates (ADRs) with CADe. A major limitation of CADe is its false positives (FPs), ranked 3rd in importance among 59 research questions in a modified Delphi consensus review. The definition of FPs varies. One commonly used definition defines an FP as an activation of the CADe system, irrespective of the number of frames or duration of time, not due to any polypoid or nonpolypoid lesions. Although only 0.07 to 0.2 FPs were observed per colonoscopy, video analysis studies using FPs as the primary outcome showed much higher numbers of 26 to 27 per colonoscopy. Most FPs were of short duration (91% < 0.5 s). A higher number of FPs was also associated with suboptimal bowel preparation. The appearance of FPs can lead to user fatigue. The polypectomy of FPs results in increased procedure time and added use of resources. Re-training the CADe algorithms is one way to reduce FPs but is not practical in the clinical setting during colonoscopy. Water exchange (WE) is an emerging method that the colonoscopist can use to provide salvage cleaning during insertion. We discuss the potential of WE for reducing FPs as well as the augmentation of ADRs through CADe.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan; (C.-P.T.); (C.-W.T.)
- School of Medicine, Tzu Chi University, Hualien City 97004, Taiwan
| | - Chia-Pei Tang
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan; (C.-P.T.); (C.-W.T.)
- School of Medicine, Tzu Chi University, Hualien City 97004, Taiwan
| | - Chih-Wei Tseng
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan; (C.-P.T.); (C.-W.T.)
- School of Medicine, Tzu Chi University, Hualien City 97004, Taiwan
| | - Tu-Liang Lin
- Department of Management Information Systems, National Chiayi University, Chiayi 60054, Taiwan;
| | - Felix W. Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA 91343, USA;
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA 90024, USA
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22
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Zhang H, Gong J, Ma LS, Jiang T, Zhang H. Effect of antifoaming agent on benign colorectal tumors in colonoscopy: A meta-analysis. World J Clin Cases 2021; 9:3607-3622. [PMID: 34046460 PMCID: PMC8130091 DOI: 10.12998/wjcc.v9.i15.3607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/25/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although several trials have shown that the addition of antifoaming agents to polyethylene glycol (PEG) can improve bowel preparation, whether PEG plus antifoaming agents have a beneficial role in the detection of benign tumors during colonoscopy has yet to be confirmed. Our aim was to clarify whether adding simethicone to PEG solution could improve the detection of benign colorectal tumors. AIM To clarify whether adding simethicone to PEG solution could improve the detection of benign colorectal tumors. METHODS The PubMed, EMBASE, and Cochrane Library databases were searched for articles published prior to September 2019. The outcomes included the detection rates of colorectal adenomas and polyps. RESULT Twenty studies were eligible. Although there was no difference in the colorectal adenoma detection rate (ADR), a significant effect of simethicone for diminutive adenomas (< 10 mm) was revealed in the group taking simethicone. We also found that simethicone could significantly improve the ADR in the proximal colon but did not affect the colorectal polyp detection rate. Furthermore, the subgroup analyses revealed a beneficial effect of simethicone on the ADR among Asians (P = 0.005) and those with an ADR < 25% (P = 0.003). Moreover, it was a significant finding that the low dose simethicone was as effective as the high dose one with respect to the detection of benign colorectal tumors. CONCLUSION In summary, the addition of simethicone to PEG might improve the detection of diminutive adenomas in the right colon by colonoscopy in Asia. Low-dose simethicone was recommended for the detection of benign colorectal tumors. However, large clinical trials are necessary to validate our results and determine the ideal dose of simethicone.
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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 Gong
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Lin-Song Ma
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Ting Jiang
- 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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23
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PAHOMEANU MR, NEGREANU L. Recent Advances in Colonic Preparation for an Accurate Colonoscopy - How to Improve Our Practice to Meet the Quality Criteria. MEDICINA MODERNA - MODERN MEDICINE 2020; 27:139-144. [DOI: 10.31689/rmm.2020.27.3.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Colorectal cancer (CRC) remains a major problem of global health. Screening colonoscopy is the gold standard in detection of CRC. A quality colonoscopy needs good indication, adequate bowel preparation, adequate examination time (30 to 45 minutes), a minimum 6 minutes time for mucosal examination during colonoscopy descent, a good centre adenoma detection rate. In 28-33% of the colonoscopies, the bowel preparation is unsatisfactory which leads to several hidden costs including the rise of preventable and treatable death rate regarding colorectal carcinoma. The ESGE (European Society of Gastrointestinal Endoscopy) recommends a maximum of 10% poor preparations, threshold that is diffi cult to reach in many centres. Newer low-volume laxative regimens for bowel cleansing are better in the fi elds of compliance and tolerability than the classic 4L PEG with 2L PEG-CS (Clensia ®) being one of the new promising low-volume formulas. The low fi bre diet is now preferred due to better compliance and tolerability.
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Affiliation(s)
- Mihai-Radu PAHOMEANU
- 2nd Department of Gastroenterology, Emergency University Hospital, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucian NEGREANU
- 2nd Department of Gastroenterology, Emergency University Hospital, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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24
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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: 1.0] [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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25
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A Randomized, Endoscopist-Blinded, Prospective Trial to Compare the Efficacy and Patient Tolerability between Bowel Preparation Protocols Using Sodium Picosulfate Magnesium Citrate and Polyethylene-Glycol (1 L and 2 L) for Colonoscopy. Gastroenterol Res Pract 2020; 2020:9548171. [PMID: 32190045 PMCID: PMC7072100 DOI: 10.1155/2020/9548171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/12/2020] [Accepted: 02/14/2020] [Indexed: 12/18/2022] Open
Abstract
Patient compliance during bowel preparation is important for successful colonoscopy. Bowel preparation with polyethylene glycol (PEG), the most commonly used solution for cleansing, involves the unpleasant ingestion of a large amount of liquid. Sodium picosulfate magnesium citrate (SP-MC) solution is an alternative option with better palatability than PEG. Therefore, in this study, we compared the efficacy and patient tolerability among the following three bowel preparation protocols: 2 L PEG-ascorbic acid (ASc), 1 L PEG-ASc plus bisacodyl, and SP-MC 340 mL plus bisacodyl. We conducted a randomized prospective endoscopist-blinded study between August 2018 and January 2019. A total of 311 patients were randomly classified into three groups according to the above-described bowel preparation protocols. To evaluate the efficacy of bowel cleansing, we used the Boston Bowel Preparation Scale. The degree of symptoms and the patients' satisfaction with each bowel preparation method were investigated using a questionnaire completed before sedation for colonoscopy. The baseline characteristics were similar among the three groups. There was no significant difference in the bowel preparation quality among the three groups. However, the incidence of symptoms, such as abdominal fullness and pain, was significantly lower (P = 0.006 and 0.027, respectively) while the patients' satisfaction rate was significantly higher (P = 0.012) in the SP-MC plus bisacodyl group than in the two PEG groups. In this study, the efficacy of the SP-MC plus bisacodyl solution was similar to that of the PEG solutions. However, patient tolerability and satisfaction were better in the SP-MC plus bisacodyl group than in the other groups. In conclusion, the use of SP-MC plus bisacodyl bowel preparation solution might be a better method for providing good intestinal cleansing and improving patient compliance.
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26
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Yang HJ, Park DI, Park SK, Lee CK, Kim HJ, Oh SJ, Moon JR, Lee BJ, Koh JS, Kim HS, Park SY, Kim DH, Chun J, Kang EA, Kim J, Soh H, Eun CS, Kim YS, Jeen YT. Novel sulfate tablet PBK-1701TC versus oral sulfate solution for colon cleansing: A randomized phase 3 trial. J Gastroenterol Hepatol 2020; 35:29-36. [PMID: 31396995 DOI: 10.1111/jgh.14826] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/13/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM PBK-1701TC is a novel sulfate tablet-based that contains 320 mg of simethicone and delivers 90% of the salt and water delivered by oral sulfate solution (OSS) preparation. This study evaluated the efficacy, safety, and tolerability of PBK-1701TC compared with OSS in bowel preparation for colonoscopy. METHODS This randomized, multicenter, phase 3 non-inferiority trial included adults aged 19 years or older with a body mass index of 19-30 kg/m2 undergoing colonoscopy at five university hospitals in Korea. The primary efficacy endpoint was successful bowel-cleansing rate, defined as Harefield Cleansing Scale grade A or B as evaluated by blinded central readers. Secondary endpoints included the presence of residual air bubbles. Adverse events and laboratory evaluations were monitored to assess safety. Tolerability was assessed via participant interview. RESULTS Overall, 235 participants were randomized, and 224 were included in the per-protocol analysis (PBK, 112; OSS, 112). Successful bowel cleansing was achieved for 95.5% (107/112) in the PBK group, which was non-inferior to the OSS group (98.2%, 110/112) with a difference of -2.7% (one sided 97.5% confidence limit, -8.1%). The participants in the PBK group had fewer intraluminal bubbles (0.9% vs 81.3%, P < 0.001) and reported a lower incidence of nausea and vomiting, with better acceptance, taste, and willingness to repeat the regimen than those in the OSS group (all P < 0.05). CONCLUSION The novel sulfate tablet, PBK-1701TC, was non-inferior to OSS with respect to bowel-cleansing efficacy and exhibited better safety and tolerability in adults undergoing colonoscopy.
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Affiliation(s)
- Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Kyun Lee
- Center for Crohn's and Colitis, Department of Gastroenterology and Hepatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyo Jong Kim
- Center for Crohn's and Colitis, Department of Gastroenterology and Hepatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Shin Ju Oh
- Center for Crohn's and Colitis, Department of Gastroenterology and Hepatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Rock Moon
- Center for Crohn's and Colitis, Department of Gastroenterology and Hepatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Beom Jae Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jin Sung Koh
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyun Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Hyun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ae Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hosim Soh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Soo Eun
- Department of Internal Medicine, Hanyang University Guri Hospital, Gyeonggi-Do, Korea
| | - You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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27
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Devereaux BM, Taylor ACF, Athan E, Wallis DJ, Brown RR, Greig SM, Bailey FK, Vickery K, Wardle E, Jones DM. Simethicone use during gastrointestinal endoscopy: Position statement of the Gastroenterological Society of Australia. J Gastroenterol Hepatol 2019; 34:2086-2089. [PMID: 31242327 DOI: 10.1111/jgh.14757] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
Abstract
Concern has been raised regarding the use of simethicone, a de-foaming agent, during endoscopic procedures. Following reports of simethicone residue in endoscope channels despite high level disinfection, an endoscope manufacturer recommended that it not be used due to concerns of biofilm formation and a possible increased risk of microorganism transmission. However, a detailed mucosal assessment is essential in performing high-standard endoscopic procedures. This is impaired by bubbles within the gastrointestinal lumen. The Gastroenterological Society of Australia's Infection Control in Endoscopy Guidelines (ICEG) Committee conducted a literature search utilizing the MEDLINE database. Further references were sourced from published paper bibliographies. Following a review of the available evidence, and drawing on extensive clinical experience, the multidisciplinary ICEG committee considered the risks and benefits of simethicone use in formulating four recommendations. Published reports have documented residual liquid or crystalline simethicone in endoscope channels after high level disinfection. There are no data confirming that simethicone can be cleared from channels by brushing. Multiple series report benefits of simethicone use during gastroscopy and colonoscopy in improving mucosal assessment, adenoma detection rate, and reducing procedure time. There are no published reports of adverse events related specifically to the use of simethicone, delivered either orally or via any endoscope channel. An assessment of the risks and benefits supports the continued use of simethicone during endoscopic procedures. Strict adherence to instrument reprocessing protocols is essential.
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Affiliation(s)
- Benedict M Devereaux
- Medical School, University of Queensland, Brisbane, Queensland, Australia.,Gastroenterological Society of Australia, Melbourne, Victoria, Australia
| | - Andrew C F Taylor
- Gastroenterological Society of Australia, Melbourne, Victoria, Australia
| | - Eugene Athan
- Barwon Health, Deakin University, Geelong, Victoria, Australia.,Australasian Society of Infectious Diseases, Hobart, Tasmania, Australia
| | - David J Wallis
- Gastroenterological Society of Australia, Melbourne, Victoria, Australia
| | - Robyn R Brown
- Gastroenterological Nurses College of Australia, Beaumaris, Victoria, Australia
| | - Sue M Greig
- Australasian College for Infection Prevention and Control, Hobart, Tasmania, Australia
| | - Fiona K Bailey
- Gastroenterological Society of Australia, Melbourne, Victoria, Australia
| | - Karen Vickery
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth Wardle
- Gastroenterological Nurses College of Australia, Beaumaris, Victoria, Australia
| | - Dianne M Jones
- Gastroenterological Nurses College of Australia, Beaumaris, Victoria, Australia
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28
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Kim H, Ko BM, Goong HJ, Jung YH, Jeon SR, Kim HG, Lee MS. Optimal Timing of Simethicone Addition for Bowel Preparation Using Polyethylene Glycol Plus Ascorbic Acid. Dig Dis Sci 2019; 64:2607-2613. [PMID: 30977077 DOI: 10.1007/s10620-019-05599-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/21/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Colonic bubbles obscure the colonic mucosa during colonoscopy following bowel preparation with polyethylene glycol plus ascorbic acid (PEG-Asc). Simethicone is used to enhance visualization during colonoscopy. We aimed to determine the optimal timing of simethicone addition to improve bowel preparation using PEG-Asc. METHODS This prospective, randomized study enrolled patients undergoing elective colonoscopy from April 2017 to January 2018. They were randomly assigned to one of the following three groups: PEG-Asc only (control) or simethicone addition in the morning on the day of colonoscopy (PEG-S1) or in the evening of the day prior to colonoscopy (PEG-S2). The primary outcome was the quality of colon cleansing, and the secondary outcomes were the adenoma detection rate (ADR), polyp detection rate (PDR), and diminutive (≤ 5 mm) ADR. RESULTS In total, 240 patients were randomly allocated to the three groups; six patients were withdrawn. Of the 234 patients evaluated, 78, 79, and 77 were allocated to the control, PEG-S1, and PEG-S2 groups, respectively. The bubble scores of all colonic segments were lowest in the PEG-S2 group. There was no significant difference in ADR or PDR among the three groups. However, the diminutive ADR was significantly higher in the PEG-S2 group compared to the other two groups (control 5.1% vs. PEG-S1 8.9% vs. PEG-S2 20.8%; P = 0.009). CONCLUSION Addition of simethicone to PEG-Asc at the optimal time prevents the formation of air bubbles and so improves the quality of bowel preparation, especially enhancing diminutive ADR.
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Affiliation(s)
- Haewon Kim
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, SoonChunHyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon and Seoul, 420-767, Korea
| | - Bong Min Ko
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, SoonChunHyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon and Seoul, 420-767, Korea.
| | - Hyeon Jeong Goong
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, SoonChunHyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon and Seoul, 420-767, Korea
| | - Yun Ho Jung
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, SoonChunHyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon and Seoul, 420-767, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, SoonChunHyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon and Seoul, 420-767, Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, SoonChunHyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon and Seoul, 420-767, Korea
| | - Moon Sung Lee
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, SoonChunHyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon and Seoul, 420-767, Korea
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Simethicone decreases bloating and improves bowel preparation effectiveness: a systematic review and meta-analysis. Surg Endosc 2019; 33:3899-3909. [PMID: 31451919 DOI: 10.1007/s00464-019-07066-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 08/14/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Simethicone is an adjunct frequently used during bowel preparation before colonoscopy and currently there is no consensus on whether it should be recommended in standard bowel preparation. We performed a systematic review and meta-analysis to determine the effect simethicone has on bowel cleanliness, adenoma detection rate (ADR), and tolerability. METHODS We searched the literature for studies that compared colon cleansing of patients that received standard bowel preparation alone and in combination with simethicone prior to colonoscopy. The primary outcomes were colon cleanliness, ADR, and tolerability. RESULTS Sixteen randomized controlled trials with 5630 patients were included in meta-analysis. Overall, polyethylene glycol (PEG) with simethicone improves colon cleansing compared with PEG alone (odds ratio [OR] 1.48, CI 1.11 to 1.97, P = 0.008). This improvement was seen for single dosing (OR 1.83, CI 1.20 to 2.79, P = 0.005) but not for split dosing (OR 1.32, CI 0.72 to 2.43, P = 0.38). Overall, simethicone had no effect on ADR (OR 1.22, CI 0.81 to 1.83, P = 0.33), but in patients receiving single dosing, simethicone significantly increased ADR (OR 1.96, CI 1.22 to 3.16, P = 0.005). The rates of nausea (OR 0.96, CI 0.75 to 1.24, P = 0.75), vomiting (OR 1.00, CI 0.69 to 1.44, P = 0.99), and abdominal pain (OR 0.69, CI 0.40 to 1.18, P = 0.17) were not significantly different between PEG and PEG + simethicone cohorts. For abdominal bloating, the PEG cohort had greater odds of experiencing bloating than the PEG + simethicone cohort (OR 2.33, CI 1.70 to 3.20, P < 0.00001). CONCLUSIONS Simethicone improves colon cleanliness and ADR; however, this improvement is not seen in patients receiving split-dose PEG. Furthermore, simethicone decreases abdominal bloating but has no effect on nausea, vomiting, and abdominal pain. Simethicone may be a useful bowel preparation adjunct in patients unable to receive split-dose PEG.
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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: 4.3] [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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Moraveji S, Casner N, Bashashati M, Garcia C, Dwivedi A, Zuckerman MJ, Carrion A, Ladd AM. The role of oral simethicone on the adenoma detection rate and other quality indicators of screening colonoscopy: a randomized, controlled, observer-blinded clinical trial. Gastrointest Endosc 2019; 90:141-149. [PMID: 30926430 DOI: 10.1016/j.gie.2019.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Combining simethicone (SIM) with a colon preparation agent has been shown to improve mucosal visibility during screening colonoscopy, but its effect on the adenoma detection rate (ADR) remains unclear. SIM is commonly used through the endoscope to eliminate bubbles during endoscopy. However, this practice recently has been associated with endoscope-transmitted infections. Our aims were to determine the role of SIM added to a polyethylene glycol preparation on the ADR, procedure times, colon preparation, and intraprocedural use of SIM. METHODS This was a randomized, controlled, observer-blinded, clinical trial of patients undergoing screening colonoscopy. Patients with a high risk of colorectal cancer were excluded. Patients were randomly assigned to 2 different preparations: polyethylene glycol plus SIM or polyethylene glycol. Two endoscopists blinded to patient preparation regimens scored its quality by using the Boston Bowel Preparation scale (BBPS) and the bubble scale. Interobserver agreement was calculated. The polyp detection rate, ADR, intraprocedural use of SIM, cecal intubation time, and withdrawal time were recorded. For study purposes, cecal intubation time and withdrawal time were combined to determine the effective procedure time. RESULTS No significant difference between the polyethylene glycol plus SIM and polyethylene glycol arms was seen regarding the ADR (33.3% vs 38.8%; P = .881) and effective procedure time (759.3 ± 253.1 seconds vs 800.2 ± 459.6 seconds; P = .373), respectively. Intraprocedural use of SIM as well as the bubble scale score were significantly lower in the polyethylene glycol plus SIM arm (1.6% vs 48.9%; P ≤ .05) and (0.1 vs 2.1; P ≤ .05), respectively. Conversely, no difference was found in the BBPS scores. The interobserver agreement for both scores was strong (bubble scale score kappa = .537; P < .05; BBPS score kappa = .184; P <.05). CONCLUSION Adding SIM to a polyethylene glycol preparation did not improve the ADR or effective procedure time. Nevertheless, it resulted in lower bubble scale scores, and more importantly, in less intraprocedural use of SIM. This simple and inexpensive intervention may have the potential to reduce the risk of endoscope-transmitted infections. (Clinical trial registration number: NCT03119168.).
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Affiliation(s)
- Sharareh Moraveji
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Nancy Casner
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Mohammad Bashashati
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Cesar Garcia
- University Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Alok Dwivedi
- Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Marc J Zuckerman
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Andres Carrion
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Antonio Mendoza Ladd
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas
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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: 8] [Impact Index Per Article: 1.3] [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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Yi LJ, Tian X, Shi B, Chen H, Liu XL, Pi YP, Chen WQ. Low-Volume Polyethylene Glycol Improved Patient Attendance in Bowel Preparation Before Colonoscopy: A Meta-Analysis With Trial Sequential Analysis. Front Med (Lausanne) 2019; 6:92. [PMID: 31134201 PMCID: PMC6512395 DOI: 10.3389/fmed.2019.00092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 04/16/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Polyethylene glycol (PEG) has been regarded as the primary recommendation for bowel preparation before colonoscopy. However, a conclusive conclusion has not yet been generated. Aim: We performed this updated meta-analysis to further investigate the comparative efficacy and safety of low volume preparation based on PEG plus ascorbic acid related to 4L PEG. Methods: A systematic search was conducted to retrieve potential randomized controlled trials (RCTs) in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 2000 to April 2018. Two independent searchers critically searched all potential citations, extracted data, and appraised risk of bias accordingly. Moreover, we used the STATA 12.0 and trial sequential analysis (TSA) 0.9 to complete all analyses. Results: A total of 13 RCTs enrolling 3,910 patients met inclusion criteria. Meta-analysis based on PP analysis indicated that compared to standard volume PEG regime, low volume regime improved patient compliance RR = 1.01; 95% CIs = 1.00, 1.03; P = 0.143 (≥75% intake); RR = 1.07; 95% CIs = 1.00, 1.14; P = 0.046 (100% intake), the willingness to repeat the same regime (RR = 1.30; 95% CIs = 1.07, 157; P = 0.007), and patient acceptability (RR = 1.18; 95% CIs = 1.07, 1.29; P = 0.001), and decreased the overall adverse events (RR = 0.86; 95% CIs = 0.77, 0.96; P = 0.009). However, no difference was observed between these two different solutions for bowel preparation efficacy (RR = 0.98; 95% CIs = 0.95, 1.02; P = 0.340). These all results were further confirmed by TSA. Conclusions: The effect of low volume regime was not inferior to the standard volume PEG regime, and low volume regime was associated with better compliance when subjects ingested all the solution, willingness to repeat the same regime, higher acceptability, and lower nausea in non-selected population.
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Affiliation(s)
- Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Xu Tian
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Bing Shi
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Hui Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Xiao-Ling Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Yuan-Ping Pi
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
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Strategies to optimise the quality of bowel cleansing. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:326-338. [PMID: 31027972 DOI: 10.1016/j.gastrohep.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/17/2022]
Abstract
Colonoscopy is the gold standard procedure for detecting neoplastic lesions of the colon and its efficiency is closely linked to the quality of the procedure. Adequate bowel preparation is a crucial factor in achieving the recommended quality indicators, but poor preparation has been reported in up to 30% of outpatients referred for colonoscopy. Consequently, over recent years, a number of studies have developed strategies to optimise bowel cleansing by improving adherence and tolerance to and the efficacy of the bowel preparation. Moreover, the identification of risk factors for inadequate bowel cleansing has led to tailored bowel preparation strategies being designed, with promising results. We aimed to review studies that assessed risk factors for inadequate bowel preparation and strategies to optimise bowel cleansing in patients at high risk of having poor preparation.
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Madhoun MF, Hayat M, Ali IA. Higher dose of simethicone decreases colonic bubbles and increases prep tolerance and quality of bowel prep: Meta-analysis of randomized controlled trials. World J Meta-Anal 2019; 7:110-119. [DOI: 10.13105/wjma.v7.i3.110] [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: 02/21/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antifoaming agents, such as simethicone, may facilitate mucosal inspection during colonoscopy. However, conflicting results have been reported with regard to the impact of simethicone on quality of bowel preparation and adenoma detection rate (ADR).
AIM To perform a meta-analysis of trials that have compared simethicone vs placebo during colonoscopy.
METHODS A reproducible literature search of multiple medical databases yielded eleven studies (n = 2605) for inclusion. Studies were compared for quality of bowel preparation, bubbles quality, ADR, and tolerability. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. Pooling was conducted by both fixed-effects and random-effects models. Relative risk (RR) estimates with a 95% confidence interval (CI) were calculated. Heterogeneity was assessed by I-squared index (I2) statistics.
RESULTS Patients’ demographic characteristics were comparable in all studies. Of the 2605 patients, 1300 were in the simethicone group, whereas 1305 were in the placebo group. Inadequate bowel preparation was much lower in the simethicone group than in the placebo group [13% vs 24.6%; RR = 0.51 (0.31-0.82); P < 0.0001]. The placebo group was more likely to have significant colonic bubbles than was the simethicone group [35% vs 8%; RR = 1.49 (1.25-1.76); P = 0.0001]. Use of simethicone resulted in a slight, statistically significant increase in ADR compared with the placebo group [26.6% vs 21.6%, RR = 1.07 (1.01-1.13); P = 0.02]. Higher doses of simethicone (> 478 mg) were more likely to result in significant reduction of inadequate bowel preparation, colonic bubbles, and to improve ADR.
CONCLUSION Adding simethicone improved the quality of bowel preparation, visualization, tolerability, and, eventually, ADR.
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Affiliation(s)
- Mohammad F Madhoun
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma, OK 73105, United States
- Veteran Affairs Medical Center, Oklahoma, OK 73105, United States
| | - Maham Hayat
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma, OK 73105, United States
- Veteran Affairs Medical Center, Oklahoma, OK 73105, United States
| | - Ijlal Akbar Ali
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma, OK 73105, United States
- Veteran Affairs Medical Center, Oklahoma, OK 73105, United States
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36
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Pan P, Zhao SB, Li BH, Meng QQ, Yao J, Wang D, Li ZS, Bai Y. Effect of supplemental simethicone for bowel preparation on adenoma detection during colonoscopy: A meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2019; 34:314-320. [PMID: 30069899 DOI: 10.1111/jgh.14401] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Although several randomized controlled trials (RCTs) have reported that supplemental simethicone (SIM) can improve bowel preparation based on polyethylene glycol, there is no consensus as to whether SIM can ultimately increase the adenoma detection rate (ADR) during colonoscopy. A meta-analysis was performed to assess the effect of SIM on ADR during colonoscopy. METHODS Databases including PubMed, EMBASE, and the Cochrane Library were searched to find relevant RCTs. RCTs evaluating the effect of pre-procedure SIM on the ADR during colonoscopy were finally included, and fixed effect models were applied. RESULTS Six trials involving 1855 patients were finally included. The present meta-analysis suggested that the ADR during colonoscopy was significantly increased by supplemental SIM (27.9% vs 23.3%, P = 0.02), with a relative risk of 1.20 (95% confidence interval 1.03-1.39). Subgroup analysis suggested that supplemental SIM may be more useful to improve ADR during colonoscopy in endoscopic centers with low baseline ADR. CONCLUSIONS Supplemental SIM for bowel preparation based on polyethylene glycol is useful to improve the ADR during colonoscopy.
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Affiliation(s)
- Peng Pan
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Sheng-Bing Zhao
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Bing-Han Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Qian-Qian Meng
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Jun Yao
- Department of Gastroenterology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Dong Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
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Li Y, Du F, Fu D. The effect of using simethicone with or without N-acetylcysteine before gastroscopy: A meta-analysis and systemic review. Saudi J Gastroenterol 2019; 25:218-228. [PMID: 31044749 PMCID: PMC6714471 DOI: 10.4103/sjg.sjg_538_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIM To assess the efficacy and safety of simethicone with or without N-acetylcysteine (NAC) as premedications before gastroscopy. MATERIALS AND METHODS We searched EMBASE, PubMed, Cochrane library and Web of Science database for randomized clinical controlled trials regarding simethicone ± NAC as oral drinking agents before gastroscopy. Statistical software RevMan5.3 was used for statistical analysis. RESULTS Ten randomized clinical trials that fulfilled the inclusion criteria were further pooled into a meta-analysis, which included 5,750 patients. The rate of positive findings in simethicone plus NAC group was higher than that in water group (risk ratio [RR] =1.31, 95%CI: 1.12-1.53, P = 0.0006) with high level of evidence. There was no significant difference on the rate of positive findings when comparing simethicone with simethicone plus NAC (RR = 1.02, 95%CI: 0.90-1.16, P = 0.71) and with water (RR = 1.13, 95%CI: 0.82-1.55, P = 0.46), respectively. Simethicone plus NAC showed better total mucosal visibility score than simethicone alone (MD = -0.14 (-0.25, -0.03), P = 0.01) without obvious heterogeneity. Both simethicone plus NAC and simethicone alone offer more benefit than water. The procedure time in simethicone group was shorter than that in water group (MD = -1.23 (-1.51, -0.96), P < 0.00001). Regarding adverse events, there was no significant difference in simethicone and water group (RR = 0.45, 95%CI: 0.2-1.0, P = 0.05, I2 = 0%). CONCLUSIONS As premedication of gastroscopy, simethicone plus NAC offers more benefit on positive findings and total mucosal visibility score.
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Affiliation(s)
- Yuanfa Li
- Department of Gastroenterology, Xiantao First People's Hospital, China,Address for correspondence: Dr. Yuanfa Li, No. 29, Mianzhoudadao Road, Sha Zui District Xiantao City, Hubei Province, China. E-mail:
| | - Fangjuan Du
- Department of Gastroenterology, Liaocheng Second People's Hospital, China
| | - Dou Fu
- Internal Medicine, Xiantao First People's Hospital, China
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Lee AHH, Lojanapiwat N, Balakrishnan V, Chandra R. Is there a difference in adenoma detection rates between gastroenterologists and surgeons? World J Gastrointest Endosc 2018; 10:109-116. [PMID: 29988847 PMCID: PMC6033718 DOI: 10.4253/wjge.v10.i6.109] [Citation(s) in RCA: 10] [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: 01/05/2018] [Revised: 03/05/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the adenoma detection rate (ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.
METHODS A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.
RESULTS The ADR was not significantly different between gastroenterologists and colorectal surgeons (34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1st degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19 (0.69-2.05).
CONCLUSION Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.
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Affiliation(s)
- Adele Hwee Hong Lee
- Eastern Health Clinical School, Monash University Clayton Campus, Melbourne 3128, Australia
| | - Nuttaradee Lojanapiwat
- Eastern Health Clinical School, Monash University Clayton Campus, Melbourne 3128, Australia
| | - Vikram Balakrishnan
- Department of Colorectal Surgery, Box Hill Hospital, Melbourne 3128, Australia
| | - Raaj Chandra
- Department of Colorectal Surgery, Box Hill Hospital, Melbourne 3128, Australia
- Royal Melbourne Hospital, Melbourne 3050, Australia
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Yi LJ, Tian X, Pi YP, Feng L, Chen H, Liu XL, Chen WQ. Comparative efficacy of low volume versus traditional standard volume PEG on bowel preparation before colonoscopy: Protocol for an updated meta-analysis with trial sequential analysis. Medicine (Baltimore) 2018; 97:e0599. [PMID: 29703060 PMCID: PMC5944532 DOI: 10.1097/md.0000000000010599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Polyethylene glycol (PEG) has been considered as the first recommendation for bowel preparation prior to colonoscopy. A previous meta-analysis suggested that low volume PEG may improve the acceptability of ingesting bowel preparation solution. However, several limitations impaired the power of findings from this published meta-analysis, such as the variation in study design of included trials and adjuvant prescriptions. Moreover, some studies related to this topic have been published recently. And thus, the aim of this updated meta-analysis is to further assess the comparative efficacy of low volume versus standard volume of PEG on bowel preparation before colonoscopy with trial sequential analysis (TSA). METHODS AND ANALYSIS Systematic searches will be performed to capture any potential randomized controlled trials (RCTs) investigated the comparative efficacy of low volume versus traditional standard volume PEG on bowel preparation prior to colonoscopy in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Moreover, we will also manually check the bibliographies of related studies and reviews so as to get additional studies. Two reviewers will independently screen the citation records, extract essential information, and appraise the risk of bias of each RCT in sequence. Finally, we will used the STATA software version 12.0 and TSA software version beta 0.9 to statistically analyze all data and test the robust of each pooled result, respectively. RESULTS We will submit the full-text of systematic review to a peer-review journal for publication. CONCLUSION This updated systematic review and meta-analysis with TSA will further assess the comparative efficacy and safety of low-volume versus traditional standard volume PEG for bowel preparation prior to colonoscopy. And then, a more comprehensive evidence body on low-volume compared to standard volume PEG in bowel preparation will be constructed.
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Affiliation(s)
- Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou
| | - Xu Tian
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
- Editorial Office, TMR Integrative Nursing, TMR Publishing Group, Tianjin
| | - Yuan-Ping Pi
- Department of Nursing, Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
| | - Ling Feng
- Department of Foundation Medicine, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Hui Chen
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
| | - Xiao-Ling Liu
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
| | - Wei-Qing Chen
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
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How AMPK and PKA Interplay to Regulate Mitochondrial Function and Survival in Models of Ischemia and Diabetes. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:4353510. [PMID: 29391924 PMCID: PMC5748092 DOI: 10.1155/2017/4353510] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/02/2017] [Indexed: 12/17/2022]
Abstract
Adenosine monophosphate-activated protein kinase (AMPK) is a conserved, redox-activated master regulator of cell metabolism. In the presence of oxidative stress, AMPK promotes cytoprotection by enhancing the conservation of energy by suppressing protein translation and by stimulating autophagy. AMPK interplays with protein kinase A (PKA) to regulate oxidative stress, mitochondrial function, and cell survival. AMPK and dual-specificity A-kinase anchoring protein 1 (D-AKAP1), a mitochondrial-directed scaffold of PKA, interact to regulate mitochondrial function and oxidative stress in cardiac and endothelial cells. Ischemia and diabetes, a chronic disease that increases the onset of cardiovascular diseases, suppress the cardioprotective effects of AMPK and PKA. Here, we review the molecular mechanisms by which AMPK and D-AKAP1/PKA interplay to regulate mitochondrial function, oxidative stress, and signaling pathways that prime endothelial cells, cardiac cells, and neurons for cytoprotection against oxidative stress. We discuss recent literature showing how temporal dynamics and localization of activated AMPK and PKA holoenzymes play a crucial role in governing cellular bioenergetics and cell survival in models of ischemia, cardiovascular diseases, and diabetes. Finally, we propose therapeutic strategies that tout localized PKA and AMPK signaling to reverse mitochondrial dysfunction, oxidative stress, and death of neurons and cardiac and endothelial cells during ischemia and diabetes.
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