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Napolitano D, Lo Cascio A, Bozzetti M, Povoli A, Grubissa S, Molino L, Marino M, Berretti D, Puca P, Lavigna DIR, Grilli F, Antonelli G, Calvez V, Di Petrillo A, Onali S, Gasbarrini A, Fiorino G, Scaldaferri F. Patient Satisfaction with IBD Undergoing Colonoscopy: A Multicenter Cross-Sectional Study. J Clin Med 2025; 14:2562. [PMID: 40283393 PMCID: PMC12027919 DOI: 10.3390/jcm14082562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Revised: 03/30/2025] [Accepted: 04/03/2025] [Indexed: 04/29/2025] Open
Abstract
Background: Colonoscopy is crucial for diagnosing and monitoring inflammatory bowel disease (IBD), assessing disease activity, and detecting dysplasia. However, patient adherence to surveillance remains suboptimal due to discomfort, anxiety, and concerns about bowel preparation. Methods: This multicenter cross-sectional study assessed patient satisfaction with colonoscopy in IBD patients across three Italian centers. Participants completed pre- and post-examination questionnaires, including the Endoscopy Customer Satisfaction Questionnaire (ECSQ) and Perceived Stress Scale (PSS-10). Clinical factors, bowel preparation methods, and healthcare provider expertise were analyzed. Results: Among 444 enrolled patients, overall satisfaction was high (98.8%) but varied across procedural phases. Higher satisfaction was predicted by expert endoscopists (β = 2.11, p = 0.012), disease remission (β = 1.70, p = 0.020), and frequent endoscopic procedures in the last 24 months (β = 0.46, p = 0.041). Conversely, severe disease activity (β = -3.87, p < 0.001) was associated with lower satisfaction. Deep sedation and high-volume bowel preparation negatively impacted satisfaction. Conclusions: Optimizing bowel preparation, enhancing healthcare provider expertise, and implementing stress-reducing strategies could improve patient adherence to surveillance guidelines in IBD care.
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Affiliation(s)
- Daniele Napolitano
- CEMAD—Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy; (D.N.); (D.I.R.L.); (F.G.); (V.C.); (A.G.); (F.S.)
| | - Alessio Lo Cascio
- Department of Nursing Research and Management, La Maddalena Cancer Center, 90146 Palermo, Italy;
| | - Mattia Bozzetti
- Direction of Health Professions, ASST Cremona, 26100 Cremona, Italy
| | - Arianna Povoli
- Department of Gastroenterology, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.P.); (S.G.); (M.M.); (D.B.)
| | - Simonetta Grubissa
- Department of Gastroenterology, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.P.); (S.G.); (M.M.); (D.B.)
| | - Luca Molino
- School of Medicine, Faculty of Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy;
| | - Marco Marino
- Department of Gastroenterology, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.P.); (S.G.); (M.M.); (D.B.)
| | - Debora Berretti
- Department of Gastroenterology, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (A.P.); (S.G.); (M.M.); (D.B.)
| | - Pierluigi Puca
- CEMAD—Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy; (D.N.); (D.I.R.L.); (F.G.); (V.C.); (A.G.); (F.S.)
| | | | - Fabio Grilli
- CEMAD—Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy; (D.N.); (D.I.R.L.); (F.G.); (V.C.); (A.G.); (F.S.)
| | - Giulio Antonelli
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, 00153 Rome, Italy
| | - Valentin Calvez
- CEMAD—Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy; (D.N.); (D.I.R.L.); (F.G.); (V.C.); (A.G.); (F.S.)
| | - Amalia Di Petrillo
- Department of Medical Sciences and Public Health, University of Cagliari, 09142 Cagliari, Italy; (A.D.P.); (S.O.)
| | - Sara Onali
- Department of Medical Sciences and Public Health, University of Cagliari, 09142 Cagliari, Italy; (A.D.P.); (S.O.)
| | - Antonio Gasbarrini
- CEMAD—Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy; (D.N.); (D.I.R.L.); (F.G.); (V.C.); (A.G.); (F.S.)
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gionata Fiorino
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Franco Scaldaferri
- CEMAD—Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy; (D.N.); (D.I.R.L.); (F.G.); (V.C.); (A.G.); (F.S.)
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Liao CH, Chen PJ, Shih YL, Chang WK, Hsieh TY, Huang TY. Factors affecting perception and acceptance of colonoscopy in patients with inflammatory bowel disease. Prev Med Rep 2025; 49:102951. [PMID: 39807183 PMCID: PMC11728065 DOI: 10.1016/j.pmedr.2024.102951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 12/16/2024] [Accepted: 12/17/2024] [Indexed: 01/16/2025] Open
Abstract
Objective The noncompliance rate with routine or surveillance colonoscopies is high, and the underlying reasons remain unverified among Asian patients with inflammatory bowel disease (IBD). This study aimed to examine the perceptions of Asian patients with IBD regarding bowel preparation and colonoscopy and their attitudes toward the recommended intervals for colonoscopies. Methods Using data from one medical center between July 2020 and May 2022, we analyzed the perceptions of bowel preparation and colonoscopy and attitudes toward examination intervals among 94 patients with IBD (Crohn's disease, 41; ulcerative colitis, 53). The patients' perceptions of the four components associated with the colonoscopy procedure (embarrassment, pain, use of bowel-cleansing agents, and stress) were assessed via a questionnaire. Patients were asked to indicate the frequency at which they had scheduled colonoscopy and the frequency at which they desired to undergo the procedure. Results "Bowel cleansing" and "pain" received the highest dissatisfaction rate. "Drink too much" was the greatest burden in bowel preparation. Younger age and younger age at diagnosis were associated with a greater burden of bowel preparation and pain. Younger patients and those diagnosed at an earlier age tended to prefer longer examination intervals. Conclusions Bowel cleansing and abdominal pain were the most uncomfortable aspects associated with colonoscopy, especially when performed without sedation, among Asian patients with IBD. Younger patients and those with early diagnoses preferred longer examination intervals. Our findings can promote colonoscopy adherence and facilitate early detection of major complications in patients at high risk and those with long-term IBD.
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Affiliation(s)
- Chang-Hung Liao
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Taiwan Society of Inflammatory Bowel Disease, Taipei, Taiwan
- Taiwan Association of Small Intestinal Disease, Taoyuan, Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Taiwan Association of Small Intestinal Disease, Taoyuan, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Taiwan Society of Inflammatory Bowel Disease, Taipei, Taiwan
- Taiwan Association of Small Intestinal Disease, Taoyuan, Taiwan
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Yang MM, Usiskin K, Ahmad HA, Ather S, Sreih A, Canavan JB, Farraye FA, Ma C. Considerations for Colorectal Neoplasia Detection in Inflammatory Bowel Disease Clinical Trials. Dig Dis 2023; 42:12-24. [PMID: 37757769 PMCID: PMC10836758 DOI: 10.1159/000533395] [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: 01/30/2023] [Accepted: 07/25/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND High-quality colonoscopic surveillance can lead to earlier and increased detection of colorectal neoplasia in patients with inflammatory bowel disease (IBD). In IBD clinical trials, endoscopy is used to assess mucosal disease activity before and after treatment but also provides an opportunity to surveil for colorectal neoplasia during follow-up. SUMMARY Best practices for colorectal cancer identification in IBD clinical trials require engagement and collaboration between the clinical trial sponsor, site endoscopist and/or principal investigator, and central read team. Each team member has unique responsibilities for maximizing dysplasia detection in IBD trials. KEY MESSAGES Sponsors should work in accordance with scientific guidelines to standardize imaging procedures, design the protocol to ensure the trial population is safeguarded, and oversee trial conduct. The site endoscopist should remain updated on best practices to tailor sponsor protocol-required procedures to patient needs, examine the mucosa for disease activity and potential dysplasia during all procedures, and provide optimal procedure videos for central read analysis. Central readers may detect dysplasia or colorectal cancer and a framework to report these findings to trial sponsors is essential. Synergistic relationships between all team members in IBD clinical trials provide an important opportunity for extended endoscopic evaluation and colorectal neoplasia identification.
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Affiliation(s)
- Mira M Yang
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Keith Usiskin
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Harris A Ahmad
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Shabana Ather
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Antoine Sreih
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - James B Canavan
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, Jacksonville, Florida, USA
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Medical Research and Development, Alimentiv Inc (formerly Robarts Clinical Trials, Inc.), London, Ontario, Canada
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Lee JM, Lee KM, Kang HS, Koo JS, Lee HS, Jeong SH, Kim JH, Kim DB. Oral Sulfate Solution Is as Effective as Polyethylene Glycol with Ascorbic Acid in a Split Method for Bowel Preparation in Patients with Inactive Ulcerative Colitis: A Randomized, Multicenter, and Single-Blind Clinical Trial. Gut Liver 2023; 17:591-599. [PMID: 36588527 PMCID: PMC10352068 DOI: 10.5009/gnl220202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/23/2022] [Accepted: 10/07/2022] [Indexed: 01/03/2023] Open
Abstract
Background/Aims Low-volume preparations for colonoscopy are gaining attention for their higher acceptability. However, the efficacy and safety of oral sulfate solution (OSS) preparations in patients with ulcerative colitis (UC) has not been well known. Therefore, we aimed to compare OSS and 2-L polyethylene glycol with ascorbic acid (PEG+Asc) for bowel preparation in inactive UC. Methods A multicenter, randomized, single-blind study was conducted at six tertiary referral hospitals in Korea. Outpatients with UC who had stable disease activity were randomly allocated to the OSS group or the 2-L PEG+Asc group for bowel preparation before colonoscopy. The study outcomes included treatment efficacy, safety, tolerability, and acceptability. Bowel cleansing was assessed using the Boston Bowel Preparation Scale and rated as successful cleansing if the score was ≥6. Patient acceptance and tolerability were assessed using a 4-point ordinal scale. Additionally, disease activity and laboratory data before and after colonoscopy were evaluated to check for safety. Results The OSS and 2-L PEG+Asc groups included 92 and 93 participants, respectively. No significant between-group difference was noted in successful cleansing (OSS [96.7%] vs 2-L PEG+Asc [97.8%], p=0.64). Moreover, the safety, acceptance, and tolerability were not significantly different (all p>0.05). Furthermore, no significant changes were found in serum electrolytes or disease activity in either group. Conclusions OSS is effective for colonoscopy cleansing, has acceptable tolerability, and does not affect disease activity; thus, it can be used safely for bowel preparation in patients with inactive UC.
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Affiliation(s)
- Ji Min Lee
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Moon Lee
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Suk Kang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ja Seol Koo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Seok-Hoo Jeong
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Dae Bum Kim
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Tulewicz-Marti E, Stępień-Wrochna B, Maciejewska K, Łodyga M, Karłowicz K, Lewandowski K, Rydzewska G. Awareness and Compliance with the Recommendations of Primary and Secondary Prevention of Cancer in Patients with Inflammatory Bowel Disease. J Pers Med 2023; 13:913. [PMID: 37373902 DOI: 10.3390/jpm13060913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Patients with Inflammatory Bowel Disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are at high risk of developing malignancies, so prevention and adherence to cancer screening may improve detection. The aim of this study was to assess compliance with medical recommendations, especially primary and secondary prevention of cancer. METHODS This one-center cross-sectional study was carried out between June and December 2021 amongst patients at the Department of Internal Medicine and Gastroenterology, IBD Division, National Medical Institute of Ministry of Interior Affairs and Administrations, or the outpatient clinic. Patients with IBD were asked to complete an anonymous questionnaire, which included 42 questions concerning lifestyle, cancer risk factors, cancer history, and checkups. STATISTICAL METHODS The results of the qualitative variables were expressed as frequencies and percentages. We used Fisher's exact test and the Chi-squared test. A value of p < 0.05 was considered significant. Statistical analyses were performed with the SPSS statistical package. RESULTS A total of 313 patients were enrolled in the study: 145 women and 168 men. In the group, 182 had Crohn's disease (CD), 120 had ulcerative colitis (UC), and 11 with IBDU (unclassified IBD). Most participants had a disease duration of over 8 years and received biological treatment, corticoids, and/or immunosuppressive therapy. Amongst respondents, 17% (31) of patients with CD and 25.8% (31) with UC were overweight, and 10.5% (19) with CD and 15.8% (19) with UC were obese (p = 0.017). We found that 16.3% of all respondents were smokers (79.6% (144) with CD, 90.8% (109) with UC, and 72.7% (8) with IBDU; p = 0.053), and 33.9% declared that they consumed alcohol (39.4% (71) with CD, 26.9% (32) with UC, and 18.2% (2) with IBDU; p = 0.045). A total of 25.4% of patients were exposed to UV radiation, but only 18.8% used sunblock. In addition, 58.8% (67) of patients with CD and 35.8% (19) with UC receiving immunosuppressants had regular laboratory tests (p = 0.02). Furthermore, 41.4% (46) of patients with UC, 27.1% (49) of patients with CD, and 70.0% (7) of patients with IBDU declared not to perform any dermatological control (p = 0.013). A total of 77% of patients had abdominal ultrasound. Out of 52.9% of patients for whom colonoscopy was recommended, only 27.3% had it performed (16.9% (30) with CD vs. 43.1% (50) with UC p < 0.001). Most examinations were ordered by gastroenterologists. Female patients had regular breast control (CD, 78.6% (66); UC, 91.2% (52); IBDU, 50% (2); p = 0.034), and 93.8% (76) had gynecological examinations. Additionally, 80.2% of patients knew about HPV, but most declared not to be vaccinated. A total of 17.9% of patients had urological control, but most had no important pathology detected. CONCLUSIONS According to our study, many patients are still exposed to risk factors, such as obesity, smoking, and low physical activity, that are modifiable. Laboratory tests in patients with immunosuppressive treatment should be performed regularly. Systematic control, especially dermatological checkups, should be recommended. Additionally, not only gastrologists but also other specialists and GPs should remind patients about regular checkups. Primary prevention, such as HPV vaccinations, should be recommended to all patients.
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Affiliation(s)
- Edyta Tulewicz-Marti
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, National Medical Institute of the Ministry of Interior Affairs and Administration-Warsaw, 02-507 Warsaw, Poland
| | - Beata Stępień-Wrochna
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, National Medical Institute of the Ministry of Interior Affairs and Administration-Warsaw, 02-507 Warsaw, Poland
| | - Katarzyna Maciejewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, National Medical Institute of the Ministry of Interior Affairs and Administration-Warsaw, 02-507 Warsaw, Poland
| | - Michał Łodyga
- Internal Medicine Department, Grochowski Hospital, 04-073 Warsaw, Poland
- Department of Internal Medicine, Faculty of Health Science, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Katarzyna Karłowicz
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, National Medical Institute of the Ministry of Interior Affairs and Administration-Warsaw, 02-507 Warsaw, Poland
| | - Konrad Lewandowski
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, National Medical Institute of the Ministry of Interior Affairs and Administration-Warsaw, 02-507 Warsaw, Poland
| | - Grazyna Rydzewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, National Medical Institute of the Ministry of Interior Affairs and Administration-Warsaw, 02-507 Warsaw, Poland
- Collegium Medicum, Jana Kochanowski University, 25-317 Kielce, Poland
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Rueda García JL, Suárez Ferrer C, Martín-Arranz E, García-Ramírez L, Sánchez-Azofra M, Poza Cordón J, Noci J, Vergés T, Blanco San Miguel P, Martín-Arranz MD. Randomized clinical trial evaluating three low-volume preparations for colonoscopy in outpatients with Inflammatory Bowel Disease: the EII-PREP trial. Scand J Gastroenterol 2022; 58:656-663. [PMID: 36519504 DOI: 10.1080/00365521.2022.2153618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Data regarding bowel preparation in patients with Inflammatory Bowel Disease (IBD) are scarce. AIM To compare efficacy, safety, and tolerability of low-volume preparations in patients with IBD. METHODS Single-center, randomized, prescriber, and colonoscopist-blinded clinical trial. IBD outpatients undergoing colonoscopy were randomized 1:1:1 to receive 1 Liter-polyethylene glycol-ascorbate (1L-PEG), 2 Liters-PEG, or sodium picosulfate (SP). The primary endpoint was percentage of quality cleansing assessed via the Boston Bowel Preparation Scale (BBPS ≥6, segments ≥2). Secondary endpoints were total high quality cleansing (BBPS 8 or 9), high-quality segmental BBPS (≥2), and patients' tolerability, symptoms, and satisfaction, assessed by questionnaires. Safety was monitored by adverse event reporting, laboratory evaluation at colonoscopy, and telephonic follow-up. RESULTS Ninety-two patients were included (33 1L-PEG, 28 2L-PEG, and 31 SP). No significant differences between preparations were observed in quality or high-quality total BBPS or high-quality segmental BBPS. Complete intake of the solution was higher for SP (p = 0.006) and lower for 1L-PEG (p = 0.02) compared to 2L-PEG intake (p = 0.55). Clinically irrelevant hyponatremia was higher in the SP group (p < 0.0001). SP instructions were easier to understand from patient's point of view (p = 0.01). Willingness to retake was higher with SP (p < 0.0001) and less for 1L-PEG (p < 0.0001). No serious adverse events were reported. CONCLUSIONS We observed no differences in efficacy between low-volume preparations in patients with IBD. Complete intake was higher for SP and lower for 1L-PEG. SP and 2L-PEG instructions were better understood and graded, and SP was more likely to be retaken. Willingness to retake was lower for 1L-PEG. No serious adverse events were reported. SUMMARY No differences in terms of efficacy were regarded in this clinical trial comparing low-volume preparations for colonoscopy in patients with IBD: however, Sodium Pisoculfate is better tolerated and accepted from patient's point of view. No serious adverse events were reported.
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Affiliation(s)
- Jose Luis Rueda García
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Cristina Suárez Ferrer
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Eduardo Martín-Arranz
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Laura García-Ramírez
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - María Sánchez-Azofra
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Joaquín Poza Cordón
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Jesús Noci
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Tamara Vergés
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Paula Blanco San Miguel
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - María Dolores Martín-Arranz
- Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,School of Medicine, Autonomous University of Madrid, Madrid, Spain
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Al Bakir I, Kabir M, Yalchin M, Hart A. Optimising inflammatory bowel disease surveillance and dysplasia management-Where do we stand? United European Gastroenterol J 2022; 10:1054-1062. [PMID: 36349435 PMCID: PMC9752268 DOI: 10.1002/ueg2.12330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/16/2022] [Indexed: 11/11/2022] Open
Abstract
Patients with longstanding extensive colitis are at an increased risk of developing colorectal cancer (CRC), and are therefore enrolled into colonoscopy screening programmes with the aim of detecting pre-cancerous dysplastic change. However, current surveillance programs face multiple limitations relating to low levels of patient enrolment, missed lesions resulting in interval cancers, and uncertainties in the management of dysplasia. Patient counselling regarding the endoscopic and surgical management options of dysplastic lesions can prove particularly challenging, due to the variable risk of progression to cancer. In this review, we discuss the histopathological diagnosis of inflammatory bowel disease (IBD)-associated dysplasia, describe the techniques to maximise dysplasia detection, and present a standardised multi-disciplinary approach to managing patients with dysplasia. The challenges presented by this patient cohort highlight the clear clinical need for further research into the development and validation of non-invasive markers of CRC risk in IBD patients undergoing surveillance.
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Affiliation(s)
- Ibrahim Al Bakir
- Gastroenterology DepartmentChelsea and Westminster HospitalLondonUK
| | - Misha Kabir
- Gastroenterology DepartmentUniversity College HospitalLondonUK
| | - Mehmet Yalchin
- Inflammatory Bowel Disease UnitSt Mark's Hospital and Academic InstituteHarrowMiddlesexUK
| | - Ailsa Hart
- Inflammatory Bowel Disease UnitSt Mark's Hospital and Academic InstituteHarrowMiddlesexUK
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Kumar A, Shenoy V, Buckley MC, Durbin L, Mackey J, Mone A, Swaminath A. Endoscopic Disease Activity and Biologic Therapy Are Independent Predictors of Suboptimal Bowel Preparation in Patients with Inflammatory Bowel Disease Undergoing Colonoscopy. Dig Dis Sci 2022; 67:4851-4865. [PMID: 35624326 DOI: 10.1007/s10620-022-07530-8] [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] [Received: 10/27/2021] [Accepted: 02/21/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Optimal bowel preparation (BP) is critical for endoscopic assessment of inflammation and dysplasia in patients with inflammatory bowel disease (IBD). Comorbidities and patient-related factors have been associated with suboptimal BP (SOBP) in the general population. We sought to identify disease-specific characteristics that may impact the quality of BP in patients with IBD. METHODS We conducted a retrospective analysis of adult IBD patients who underwent outpatient colonoscopies between January 2014 and September 2020 at a large academic medical center. Quality of BP was documented using the Boston Bowel Preparation Scale (BBPS) or the Aronchick scale and dichotomized into "suboptimal" (BBPS 0-5 or Aronchick "fair," "poor," unsatisfactory") and "optimal" (BBPS 6-9 or Aronchick "excellent," "good"). IBD-specific and other factors associated with SOBP were evaluated using logistic regression analyses. RESULTS Among a total of 395 IBD patients [54% males, mean age 40 years, 63% with Crohn's disease (CD), 35% with ulcerative colitis (UC)], 24.8% had SOBP. On multivariable analysis, moderate-to-severe endoscopic disease vs mild or inactive disease was associated with a higher odds of SOBP [adjusted OR 2.7(95% CI 1.52-4.94)], whereas baseline biologic use was associated with a lower odds of SOBP [aOR 0.24(0.09-0.65)] among the overall IBD cohort. Additionally, age > 65 years [aOR 2.99(1.19-7.54)] and single-dose vs split-dose BP [aOR 2.37(1.43-3.95)] were predictors of SOBP. In the subgroup analysis by IBD type, moderate-to-severe endoscopic disease predicted SOBP among both CD and UC cohorts. CONCLUSION Endoscopic disease activity was predictive of SOBP, and biologic therapy was protective against SOBP among IBD patients.
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Affiliation(s)
- Anand Kumar
- Division of Gastroenterology, Lenox Hill Hospital, 100 E 77th St, New York, NY, 10075, USA. .,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Vinayak Shenoy
- Division of Gastroenterology, Lenox Hill Hospital, 100 E 77th St, New York, NY, 10075, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Megan C Buckley
- Division of Gastroenterology, Lenox Hill Hospital, 100 E 77th St, New York, NY, 10075, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Laura Durbin
- Division of Gastroenterology, Lenox Hill Hospital, 100 E 77th St, New York, NY, 10075, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - James Mackey
- Division of Gastroenterology, Lenox Hill Hospital, 100 E 77th St, New York, NY, 10075, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Anjali Mone
- Division of Gastroenterology, Lenox Hill Hospital, 100 E 77th St, New York, NY, 10075, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Arun Swaminath
- Division of Gastroenterology, Lenox Hill Hospital, 100 E 77th St, New York, NY, 10075, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Feinstein Institutes for Medical Research, Institute of Health System Science, Manhasset, NY, USA
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9
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Gajera A, South C, Cronley KM, Ziebert JJ, Wrigh CH, Levitan O, Burleson DB, Johnson DA. High-Volume Colonic Lavage Is a Safe and Preferred Colonoscopy Preparation for Patients With Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2022; 4:otac024. [PMID: 36777430 PMCID: PMC9802306 DOI: 10.1093/crocol/otac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Colonoscopies provide a crucial diagnostic and surveillance tool for inflammatory bowel disease (IBD). Accordingly, IBD patients undergo repeated and frequent colonoscopies. The oral purgative bowel prep (BP) is often burdensome on patients, resulting in delayed or missed colonoscopies due to patient noncompliance. Additionally, oral BP has been noted to possibly induce colon mucosal inflammatory changes in some patients, which may be misleading when assessing actual disease activity. METHODS In this retrospective clinical study, we evaluated the use of an FDA cleared, defecation-inducing high-volume colon irrigation (>40 L) BP to prepare IBD patients for colonoscopy. Data were collected at 4 US Hygieacare centers from September 2016 to March 2021. The IBD patient population consisted of 314 patients that underwent 343 BPs. The BPs were prescribed by 65 physicians and performed by 16 nurses and technicians. RESULTS Patient ages were 20-85 years old, 76% females, 24% males, and 97% of the patients were adequately prepared for their colonoscopy (n = 309). Patient satisfaction with the BP was very high, as reflected in postprocedure surveys and open-ended responses text analyses, and there were no serious adverse events. CONCLUSIONS We present data supporting that the defecation-inducing high-volume colon irrigation BP for colonoscopy is safe, effective, and preferred for IBD patients. Using this BP for IBD patients can allow earlier interventions, significantly impacting disease management and future outcomes.
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Affiliation(s)
- Amit Gajera
- Ohio GI & Gastro Health, Norwood Endoscopy Center, Cincinnati, Ohio, USA
| | - Christopher South
- Ohio GI & Gastro Health, Norwood Endoscopy Center, Cincinnati, Ohio, USA
| | - Kevin M Cronley
- Ohio GI & Gastro Health, Norwood Endoscopy Center, Cincinnati, Ohio, USA
| | - John J Ziebert
- Austin Gastro & GI Alliance, Endoscopy Center I (North) Austin, TexasUSA
| | - Cynthia H Wrigh
- GI Alliance, GI Associates and Endoscopy Center, Flowood, Mississippi, USA
| | - Orly Levitan
- Hygieacare Inc., Clinical & Regulatory, Norfolk, Virginia, USA
| | - Dawn B Burleson
- Hygieacare Inc., Clinical & Regulatory, Norfolk, Virginia, USA
| | - David A Johnson
- Eastern VA Medical School, Chief of Gastroenterology, Norfolk, Virginia, USA
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10
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Steenholdt C, Jensen JT, Brynskov J, Møller AM, Limschou AC, Konge L, Vilmann P. Patient Satisfaction of Propofol Versus Midazolam and Fentanyl Sedation During Colonoscopy in Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2022; 20:559-568.e5. [PMID: 33371995 DOI: 10.1016/j.cgh.2020.10.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Colonoscopy is essential for optimal management of inflammatory bowel disease. However, many patients opt out due to unpleasantness related to this procedure. We investigated if Nurse Administered Propofol Sedation (NAPS) would improve patient satisfaction and attitude towards future colonoscopies. METHODS Randomized clinical trial of deep sedation with NAPS (n = 63) versus moderate midazolam and fentanyl sedation (n = 67). To assess the primary end point of patient satisfaction at discharge, we developed a Satisfaction Questionnaire comprising 13 items each rated by a 5-point Likert scale and with higher scores reflecting more positive outcomes (13-65 points). RESULTS Fifty-six patients (43%) with ulcerative colitis, 48 (37%) with Crohn's disease, and 26 (20%) with high suspicion of inflammatory bowel disease were included. Most (88%) had previously had a colonoscopy and pre-procedure expectations were similar between groups. Patients receiving deep sedation had significantly higher satisfaction score (mean 60.1, SD 3.4) than those receiving moderate sedation (51.2, 8.4; P < .001). This was driven especially by less pain, more amnesia, sedation more to their liking, and better experience with the current than previous sedations. Importantly, these patients significantly more often preferred the same sedation for a future colonoscopy and were also inclined to accept more frequent colonoscopies. Assistance from another colonoscopist and disruption of the procedure due to pain occurred significantly more frequent in the moderate sedation group. There were no safety signals associated with NAPS. CONCLUSIONS Patients with inflammatory bowel disease favor deep propofol sedation over moderate midazolam and fentanyl sedation. Availability of NAPS may facilitate patient adherence to endoscopy-based monitoring programs. Clinicaltrials.gov NCT01934088.
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Affiliation(s)
- Casper Steenholdt
- Department of Gastroenterology, Herlev-Gentofte University Hospital, Herlev, Denmark.
| | - Jeppe T Jensen
- Department of Gastroenterology, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Jørn Brynskov
- Department of Gastroenterology, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Ann Merete Møller
- Department of Anaesthesiology, Herlev-Gentofte University Hospital, Herlev, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Copenhagen, Copenhagen, Denmark
| | - Peter Vilmann
- Department of Gastroenterology, Herlev-Gentofte University Hospital, Herlev, Denmark
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11
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Wijnands AM, te Groen M, Peters Y, Kaptein AA, Oldenburg B, Hoentjen F, Lutgens MWMD. Patients Prioritize a Low-volume Bowel Preparation in Colitis-associated Colorectal Cancer Surveillance: A Discrete Choice Experiment. Inflamm Bowel Dis 2021; 28:1053-1060. [PMID: 34487155 PMCID: PMC9247845 DOI: 10.1093/ibd/izab221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) undergo surveillance colonoscopies at fixed intervals to reduce the risk of colorectal cancer (CRC). Taking patients' preferences for determining surveillance strategies into account could improve adherence and patient satisfaction. This study aimed to determine patient preferences for CRC surveillance in IBD. METHODS We conducted a web-based, multicenter, discrete choice experiment among adult IBD patients with an indication for surveillance. Individuals were repeatedly asked to choose between 3 hypothetical surveillance scenarios. The choice tasks were based on bowel preparation (0.3-4 L), CRC risk reduction (8% to 1%-6%), and interval (1-10 years). Attribute importance scores, trade-offs, and willingness to participate were calculated using a multinomial logit model. Latent class analysis was used to identify subgroups with similar preferences. RESULTS In total, 310 of 386 sent out questionnaires were completed and included in the study. Bowel preparation was prioritized (attribute importance score 40.5%) over surveillance interval and CRC risk reduction (31.1% and 28.4%, respectively). Maximal CRC risk reduction, low-volume bowel preparation (0.3 L laxative with 2 L clear liquid) with 2-year surveillance was the most preferred combination. Three subgroups were identified: a "surveillance avoidant," "CRC risk avoidant," and "surveillance preferring" groups. Membership was correlated with age, educational level, perceived CRC risk, the burden of bowel preparation, and colonoscopies. CONCLUSIONS Inflammatory bowel disease patients consider bowel preparation as the most important element in acceptance of CRC surveillance. Heterogeneity in preferences was explained by 3 latent subgroups. These findings may help to develop an individualized endoscopic surveillance strategy in IBD patients.
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Affiliation(s)
- Anouk M Wijnands
- Address correspondence to: Anouk M. Wijnands, MD, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, P.O. Box 85500, Internal Mail No. F02.618, 3508 GA Utrecht, the Netherlands ()
| | | | - Yonne Peters
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bas Oldenburg
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Neri B, Scarozza P, Giannarelli D, Sena G, Mossa M, Lolli E, Calabrese E, Biancone L, Grasso E, Di Iorio L, Troncone E, Monteleone G, Paoluzi OA, Del Vecchio Blanco G. Efficacy and tolerability of very low-volume bowel preparation in patients with inflammatory bowel diseases. Eur J Gastroenterol Hepatol 2021; 33:977-982. [PMID: 34034275 DOI: 10.1097/meg.0000000000002167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES An adequate bowel preparation is essential for a quality colonoscopy. Patients with inflammatory bowel disease (IBD) show low compliance with bowel preparation due to the large volume of lavage solution to be ingested, especially if active symptoms are present, and the frequency of having a colonoscopy. We evaluated the efficacy and tolerability of a very low-volume (VLV) polyethylene glycol (PEG)-based solution in patients with IBD. METHODS A cohort of 103 consecutive patients, 56 with Crohn's disease and 47 with ulcerative colitis, received a 1-L PEG-based bowel preparation divided into two 500-mL doses taken the evening before and the morning of the colonoscopy, each dose followed by at least another 500-mL of clear fluids. Colon cleansing was scored according to the Boston Bowel Preparation Scale (BBPS) and evaluated in relation to influencing variables. RESULTS Bowel cleansing was adequate (BBPS ≥ 6) in 88 patients (85.4%). The time interval between the end of bowel preparation and the beginning of colonoscopy and the disease activity significantly affected colon cleansing. Most patients declared a complete intake of lavage solution (99%), the willingness to repeat the same bowel preparation in a future colonoscopy (86.4%), and a good taste assessment. CONCLUSION The VLV PEG-based bowel preparation is effective and well accepted by IBD patients. As minimizing the volume of lavage solution required, the VLV-bowel preparation here tested could be of choice in subjects who perform periodically colonoscopy or in those who do not tolerate a larger amount of liquids.
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Affiliation(s)
- Benedetto Neri
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Patrizio Scarozza
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Diana Giannarelli
- Department of Biostatistics and Bioinformatics, UOSD Clinical Trial Center, Regina Elena National Cancer Institute IRCCS of Rome, Rome, Italy
| | - Giorgia Sena
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Michelangela Mossa
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Elisabetta Lolli
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Livia Biancone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Enrico Grasso
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Laura Di Iorio
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Edoardo Troncone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata"
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13
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Mohsen W, Williams AJ, Wark G, Sechi A, Koo JH, Xuan W, Bassan M, Ng W, Connor S. Prospective single-blinded single-center randomized controlled trial of Prep Kit-C and Moviprep: Does underlying inflammatory bowel disease impact tolerability and efficacy? World J Gastroenterol 2021; 27:1090-1100. [PMID: 33776375 PMCID: PMC7985733 DOI: 10.3748/wjg.v27.i11.1090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/11/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonoscopy remains the gold standard for detection of colonic disease. An optimal evaluation depends on adequate bowel cleansing. Patients with inflammatory bowel disease (IBD), require frequent endoscopic assessment for both activity and dysplasia assessment. Two commonly used bowel preparations in Australia are Prep Kit-C (Pc) and Moviprep (Mp). Little is known about tolerability, efficacy and safety of split protocols of Mp and Pc in both IBD and non-IBD patients.
AIM To primary aim was to compare the tolerability, efficacy and safety of split protocols of Mp and Pc in patients having a colonoscopy. The secondary aim was to compare the efficacy, tolerability and safety of either preparation in patients with or without IBD.
METHODS Patients were randomized to Pc or Mp bowel preparation. Patients completed a questionnaire to assess tolerability. Efficacy was assessed using the Ottawa Bowel Preparation Score. Serum electrolytes and renal function were collected one week prior to colonoscopy and on the day of colonoscopy.
RESULTS Of 338 patients met the inclusion criteria. Of 168 patients randomized to Mp and 170 to Pc. The efficacy of bowel preparation (mean Ottawa Bowel Preparation Score) was similar between Mp (5.4 ± 2.4) and Pc (5.1 ± 2.1) (P = 0.3). Mean tolerability scores were similar in Mp (11.84 ± 5.4) and Pc (10.99 ± 5.2; P = 0.17). 125 patients had IBD (73 had Crohn’s Disease and 52 had Ulcerative colitis). Sixty-four IBD patients were allocated to Mp and 61 to Pc. In non-IBD patients, 104 were allocated to Mp and 109 to Pc. The mean tolerability score in the IBD group was lower than the non-IBD group (mean tolerability scores: IBD: 10.3 ± 5.1 and non-IBD: 12.0 ± 5.3; P = 0.01). IBD patients described more abdominal pain with Mp when compared with Pc; (Mp: 5.7 ± 4.4 vs Pc: 3.6 ± 2.6, P = 0.046). Serum magnesium level increased with Pc compared with Mp in all patients (mean increase in mmol/L: Mp: 0.03 ± 0.117 and Pc: 0.11 ± 0.106; P < 0.0001).
CONCLUSION In this study, the efficacy, tolerability and safety of Mp and Pc were similar in all patients. However, patients with IBD reported lower tolerability with both preparations. Specifically, IBD patients had more abdominal pain with Mp. These results should be considered when recommending bowel preparation especially to IBD patients.
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Affiliation(s)
- Waled Mohsen
- Department of Digestive Diseases, Gold Coast University Hospital, Gold Coast, 4215, Queensland, Australia
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Astrid-Jane Williams
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney 2170, New South Wales, Australia
| | - Gabrielle Wark
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Alexandra Sechi
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Jenn-Hian Koo
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Wei Xuan
- South West Sydney Clinical School, University of New South Wales, Sydney 2170, New South Wales, Australia
- Ingham Institute Applied Medical Research, Sydney 2170, New South Wales, Australia
| | - Milan Bassan
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Watson Ng
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney 2170, New South Wales, Australia
| | - Susan Connor
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney 2170, New South Wales, Australia
- Ingham Institute Applied Medical Research, Sydney 2170, New South Wales, Australia
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14
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Bezzio C, Schettino M, Manes G, Andreozzi P, Arena I, Della Corte C, Costetti M, Devani M, Omazzi BF, Saibeni S. Tolerability of Bowel Preparation and Colonoscopy in IBD Patients: Results From a Prospective, Single-Center, Case-Control Study. CROHN'S & COLITIS 360 2020; 2:otaa077. [PMID: 36777747 PMCID: PMC9802087 DOI: 10.1093/crocol/otaa077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Indexed: 11/12/2022] Open
Abstract
Background Endoscopy plays a fundamental role in the management of patients with inflammatory bowel disease (IBD). The aim of this study was to prospectively evaluate the tolerability and efficacy of bowel preparation and colonoscopy in ulcerative colitis (UC) and Crohn's disease (CD) patients compared to subjects participating in a colorectal cancer population screening program. Methods Consecutive enrolment of CD and UC patients and screening subjects (SS) undergoing colonoscopy. Bowel preparation was done by split dose of 2 L PEG-ELS + simethicone. We recorded endoscopic, clinical, and demographic features; cleanliness rating using the Boston Bowel Preparation Scale (BBPS); and sedation doses. Bowel-preparation tolerability, discomfort, and pain during colonoscopy were assessed using a Visual Analogue Scale from 0 to 100 mm. Results Sixty-three UC (mean age 49.9 ± 14.9 years), 63 CD (mean age 44.0 ± 14.0 years), and 63 SS (mean age 59.9 ± 6.3 years) patients were enrolled. Bowel preparation was similarly tolerated in UC, CD, and SS (P = 0.397). A complete colonoscopy was similarly performed in UC (59/63, 93.7%), CD (58/63, 92.1%), and SS (60/63, 95.2%) (P = 0.364). The BBPS did not show significant differences between UC (6.2 ± 1.6), CD (6.1 ± 1.3), and SS (6.2 ± 1.4) (P = 0.824). The need to increase sedation doses was significantly higher in CD (24/63, 38.1%) and UC (16/63, 25.4%) than in SS (4/63, 6.3%) (P < 0.0001). Conclusions Bowel preparation is equally tolerated and efficacious in IBD patients and in healthy SS. In IBD, higher sedation doses are needed to guarantee an equally tolerated colonoscopy.
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Affiliation(s)
- Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Mario Schettino
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Gianpiero Manes
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Paolo Andreozzi
- Gastroenterology Unit, ASL Caserta, Marcianise Hospital, Marcianise, Italy
| | - Ilaria Arena
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | | | - Martina Costetti
- Department of Internal Medicine, San Matteo Hospital and University of Pavia, Pavia, Italy
| | - Massimo Devani
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | | | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy,Address correspondence to: Simone Saibeni, MD, PhD, Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, I-20017 Rho (MI), Italy ()
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15
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Iacucci M, Cannatelli R, Tontini GE, Panaccione R, Danese S, Fiorino G, Matsumoto T, Kochhar GS, Shen B, Kiesslich R, Ghosh S. Improving the quality of surveillance colonoscopy in inflammatory bowel disease. Lancet Gastroenterol Hepatol 2020; 4:971-983. [PMID: 31696831 DOI: 10.1016/s2468-1253(19)30194-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
Abstract
Several recommendations have addressed the topic of improving the quality of surveillance colonoscopy in inflammatory bowel disease. However, there is variation between these recommendations, in part due to the absence of well-defined quality indicators, suggesting that these quality indicators should be studied and developed. We did a systematic review of evidence related to surveillance colonoscopy in inflammatory bowel disease to look at the different variables in this practice and offer a critique of the quality control measures before, during, and after the procedure. We identified several key quality measures that could be adopted in clinical practice, including control of inflammation, optimal bowel preparation, ideal time allocation, training, sedation, detection and characterisation of lesions, therapeutic management of the lesions, and colonoscopic reports. However, further primary research and consensus reports are needed to continue developing roadmaps at a global level.
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Affiliation(s)
- Marietta Iacucci
- Institute of Translational of Medicine, NIHR Biomedical Research Centre, University of Birmingham and University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, NIHR Biomedical Research Centre, University of Birmingham and University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Rosanna Cannatelli
- Institute of Translational of Medicine, NIHR Biomedical Research Centre, University of Birmingham and University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, NIHR Biomedical Research Centre, University of Birmingham and University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK; Department of Gastroenterology, Spedali Civili di Brescia, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Remo Panaccione
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Silvio Danese
- Inflammatory Bowel Diseases Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gionata Fiorino
- Inflammatory Bowel Diseases Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Takayuki Matsumoto
- Department of Gastroenterology, Iwate Medical University, Morioka, Japan
| | - Gursimran S Kochhar
- Department of Gastroenterology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Bo Shen
- Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Kiesslich
- Department of Medicine, Helios HSK Wiesbaden, Wiesbaden, Germany
| | - Subrata Ghosh
- Institute of Translational of Medicine, NIHR Biomedical Research Centre, University of Birmingham and University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, NIHR Biomedical Research Centre, University of Birmingham and University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK
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16
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Rottoli M, Tanzanu M, Di Candido F, Colombo F, Frontali A, Chandrasinghe PC, Pellino G, Frasson M, Warusavitarne J, Panis Y, Sampietro GM, Spinelli A, Poggioli G. Risk factors for locally advanced cancer associated with ulcerative colitis: Results of a retrospective multicentric study in the era of biologics. Dig Liver Dis 2020; 52:33-37. [PMID: 31582324 DOI: 10.1016/j.dld.2019.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients affected by ulcerative colitis (UC) are more likely to develop colorectal cancer, and are often diagnosed with lymph node involvement (N+) at surgery. AIM To identify the risk factors for N+ cancer in UC patients. METHODS Patients undergoing surgery from 2001 to 2018 in six European tertiary centres were included. N+ patients were compared to the control group (N-) for clinical variables. The evaluation of risk factors for N+ was assessed using univariate and multivariable logistic regression analyses. RESULTS A total of 130 patients were included. Median duration of disease was 21 years (1-52). Forty patients (30.8%) were N+ at surgery. Eighteen (13.8%) developed cancer within 10 years from the onset of UC. Younger age at surgery (Odds ratio -OR- 0.96, p = 0.042), left colon location (OR 2.44, p = 0.045) and the presence of stricture (OR 5.07, p = 0.002) were associated with N+. CONCLUSION Location in the left colon, presence of strictures and younger age strongly correlated with a higher risk of N+ cancer, which could develop before the starting point of surveillance. Duration, extension and severity of disease were not associated with N+. These results should be considered in the evaluation of risk of advanced cancer in UC patients.
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Affiliation(s)
- Matteo Rottoli
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Marta Tanzanu
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Di Candido
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Francesco Colombo
- Department of Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Alice Frontali
- Beaujon Hospital, Department of Colorectal Surgery and University Paris VII, France
| | | | - Gianluca Pellino
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - Matteo Frasson
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | | | - Yves Panis
- Beaujon Hospital, Department of Colorectal Surgery and University Paris VII, France
| | | | - Antonino Spinelli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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17
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Taylor CC, Millien VO, Hou JK, Massarweh NN. Association Between Inflammatory Bowel Disease and Colorectal Cancer Stage of Disease and Survival. J Surg Res 2019; 247:77-85. [PMID: 31767275 DOI: 10.1016/j.jss.2019.10.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/16/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). However, there are few data comparing outcomes between IBD and non-IBD-associated CRC. METHODS Retrospective cohort study of patients with CRC identified from the Veteran Affairs (VA) Central Cancer Registry from 1998 to 2012 linked to national VA administrative claims to identify patients with IBD using a previously validated algorithm. The association between IBD status and stage of disease and overall risk of death were evaluated using multivariable logistic and Cox regression, respectively. RESULTS Among 34,570 CRC patients, 217 had IBD. IBD patients were significantly younger for both colon and rectal cancer. IBD patients who developed rectal cancer were significantly more likely to present with locally advanced or metastatic disease (P = 0.007), but there was no difference in stage among patients with colon cancer. This difference persisted after multivariable adjustment (overall-odds ratio [OR] 1.40, 95% confidence interval [1.03-1.90]; colon-OR 1.22 [0.84-1.78]; rectum-OR 2.04 [1.22-3.40]). Total colectomy was more commonly performed among IBD patients. Overall, IBD was associated with a 52% increased risk of death (hazard ratio 1.52 [1.21-1.91]). CONCLUSIONS Although IBD is associated with more advanced stage at diagnosis for rectal cancer, it is associated with a worse survival primarily in patients with colon cancer. Further work is needed to better understand the reason for these observed differences between IBD and non-IBD patients and to better delineate the impact of endoscopic surveillance on CRC care and outcomes in IBD patients.
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Affiliation(s)
- Christopher C Taylor
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Valentine O Millien
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Jason K Hou
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas
| | - Nader N Massarweh
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas.
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18
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Friedman S. DDS Profile: Sonia Friedman, MD. Dig Dis Sci 2019; 64:2703-2705. [PMID: 31388857 DOI: 10.1007/s10620-019-05764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Sonia Friedman
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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19
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Briot C, Faure P, Parmentier AL, Nachury M, Trang C, Viennot S, Altwegg R, Bulois P, Thomassin L, Serrero M, Ah-Soune P, Gilletta C, Plastaras L, Simon M, Dray X, Caillo L, Del Tedesco E, Abitbol V, Zallot C, Degand T, Rossi V, Bonnaud G, Colin D, Morel B, Winkfield B, Danset JB, Filippi J, Amiot A, Attar A, Levy J, Peyrin-Biroulet L, Vuitton L. Efficacy, Tolerability, and Safety of Low-Volume Bowel Preparations for Patients with Inflammatory Bowel Diseases: The French Multicentre CLEAN Study. J Crohns Colitis 2019; 13:1121-1130. [PMID: 30785181 DOI: 10.1093/ecco-jcc/jjz040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Standard high-volume polyethylene glycol [PEG] bowel preparations [PEG-4L] are recommended for patients with inflammatory bowel disease [IBD] undergoing colonoscopy. However, low-volume preparations [≤2 L of active volume] are often used in clinical practice. The aim of this study was to evaluate the efficacy, tolerability, and safety of the various bowel preparations for patients with IBD, including low-volume preparations. METHODS We conducted a French prospective multicentre observational study over a period of 1 month. Patients aged 18-75 years with IBD with an indication of colonoscopy independent of the study were enrolled. The choice of the preparation was left to the investigators, as per their usual protocol. The patients' characteristics, disease, and colonoscopy characteristics were recorded, and they were given self-reported questionnaires. RESULTS Twenty-five public and private hospitals enrolled 278 patients. Among them, 46 had a disease flare and 41 had bowel stenoses. Bowel preparations for colonoscopy were as follows: 42% received PEG-2L, 29% received sodium picosulfate [Pico], 15% received PEG-4L, and 14% had other preparations. The preparation did not reach the Boston's score efficacy outcome in the PEG-4L group in 51.2% of the patients [p = 0.0011]. The preparation intake was complete for 59.5% in the PEG-4L group, compared with 82.9% in the PEG-2L group and 93.8% in the Pico group [p < 0.0001]. Tolerability, as assessed by the patients' VAS, was significantly better for both Pico and PEG-2L compared with PEG-4L, and better for Pico compared with PEG-2L [p = 0.008; p = 0.0003]. In multivariate analyses, low-volume preparations were independent factors of efficacy and tolerability. Adverse events occurred in 4.3% of the patients. CONCLUSIONS Preparations with PEG-2L and Pico were equally safe, with better efficacy and tolerability outcomes compared with PEG-4L preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation.
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Affiliation(s)
- C Briot
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
| | - P Faure
- Department of Gastroenterology, Clinique Pasteur, Toulouse, France
| | - A L Parmentier
- Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France
| | - M Nachury
- Gastroenterology Department, University Hospital of Lille, Lille, France
| | - C Trang
- Department of Hepatology and Gastroenterology, University Hospital Hotel Dieu, Nantes, France
| | - S Viennot
- Gastroenterology Department, University Hospital of Caen, Caen, France
| | - R Altwegg
- Department of Hepatology and Gastroenterology, University Hospital of St Eloi, Montpellier, France
| | - P Bulois
- Department of Gastroenterology, Hôpital Privé la Louvière, Ramsay Générale de Santé, Lille, France
| | - L Thomassin
- Department of Gastroenterology, University Hospital Charles Nicolle, Rouen, France
| | - M Serrero
- Department of Gastroenterology, APHM, Hopital Nord, Marseille, France
| | - P Ah-Soune
- Department of Hepatology and Gastroenterology, Toulon - La Seyne-sur-Mer Hospital, Toulon, France
| | - C Gilletta
- Department of Gastroenterology, University Hospital Rangueuil, Toulouse, France
| | - L Plastaras
- Department of Hepato-Gastroenterology, Hospital Pasteur, Colmar, France
| | - M Simon
- Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
| | - X Dray
- Department of Gastroenterology, Sorbonne University & APHP, Hôpital Saint-Antoine, Paris, France
| | - L Caillo
- Department of Gastroenterology and Hepatology, University Hospital Caremeau, Nimes, France
| | - E Del Tedesco
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - V Abitbol
- Department of Gastroenterology, University Hospital Cochin, Paris, France
| | - C Zallot
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - T Degand
- Department of Gastroenterology, University Hospital Le Bocage, Dijon, France
| | - V Rossi
- Department of Gastroenterology, Hospital Haut Anjou, Château Gontier, France
| | - G Bonnaud
- Clinique Ambroise Paré, Toulouse, France
| | - D Colin
- Department of Gastroenterology, Clinique de la Miotte, Belfort, France
| | - B Morel
- Department of Gastroenterology, Centre Hospitalier de Villefranche-sur-Saône, Gleizé, France
| | - B Winkfield
- Department of Hepatology and Gastroenterology, Hôpital Nord Franche-Comté, Trevenans, France
| | - J B Danset
- Department of HepatoGastroenterology, European Georges-Pompidou Hospital, APHP, Paris, France
| | - J Filippi
- Department of Gastroenterology, University Hospital L'Archet, Nice, France
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France
| | - A Attar
- Gastroenterology Department, Beaujon University Hospital, Clichy, France
| | - J Levy
- Department of Gastroenterology, Clinique des Cèdres, Cornebarrieu, France
| | - L Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - L Vuitton
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
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20
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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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21
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Gulati S, Dubois P, Carter B, Cornelius V, Martyn M, Emmanuel A, Haji A, Hayee B. A Randomized Crossover Trial of Conventional vs Virtual Chromoendoscopy for Colitis Surveillance: Dysplasia Detection, Feasibility, and Patient Acceptability (CONVINCE). Inflamm Bowel Dis 2019; 25:1096-1106. [PMID: 30576449 DOI: 10.1093/ibd/izy360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/27/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chromoendoscopy (CE) is the recommended surveillance technique for colitis, but uptake has been limited and the literature provides scant information on patient experience (PE); imperative to adherence to surveillance programmes. Virtual CE (VCE) by Fujinon Intelligent Colour Enhancement digitally reconstructs mucosal images in real time, without the technical challenges of CE. We performed a multifaceted randomized crossover trial (RCT) to evaluate study feasibility and obtain preliminary comparative procedural and PE data. METHODS Patients were randomized to undergo either CE with indigo carmine or VCE as the first procedure. After 3-8 weeks, participants underwent colonoscopy with the second technique. Patient recruitment/retention, missed dysplasia, prediction of dysplasia, and contamination (memory/sampling of the first procedure) were recorded. PE was assessed by validated questionnaires, and pain was assessed using a visual analog scale (mm). RESULTS Sixty patients were recruited, and 48 patients (first procedure: 23 VCE, 25 CE) completed the trial (retention 80%) with no episodes of contamination. Eleven dysplastic lesions were detected in n = 7/48 (14.5%). VCE missed 1 lesion, and CE missed 2 lesions in n = 2 (data of VCE vs CE, respectively, for dysplasia diagnostic accuracy: 93.94% [85.2%-98.32%] vs 76.9% [66.9%-98.2%]; examination time [minutes]: 14 +/- 4 vs 20 +/- 7 (95% confidence interval, 3.5 to 8; P < 0.001); pain (mm): 27.4 +/- 17.5 vs 34.7 +/- 18; patient preference: 67% [n = 31] vs 33% [n = 15] in n = 46; P < 0.001). CONCLUSIONS This is the first RCT to include validated PE in a colitis surveillance program. VCE is safe, technically easier, quicker, and more comfortable test, with dysplasia detection at least as good as that of CE, overcoming many barriers to the wider adoption of CE. This trial may serve as a successful foundation for a a multicenter trial to confirm the value of VCE for colitis surveillance.
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Affiliation(s)
- Shraddha Gulati
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick Dubois
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Ben Carter
- Biostatistics and Health Informatics, King's College London, London, UK
| | | | - Meredith Martyn
- Clinical Trial Statistics, Imperial College London, London, UK
| | - Andrew Emmanuel
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Amyn Haji
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Bu'Hussain Hayee
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
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22
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Burnett-Hartman AN, Hua X, Rue TC, Golchin N, Kessler L, Rowhani-Rahbar A. Risk interval analysis of emergency room visits following colonoscopy in patients with inflammatory bowel disease. PLoS One 2019; 14:e0210262. [PMID: 30625217 PMCID: PMC6326490 DOI: 10.1371/journal.pone.0210262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/04/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS Prior studies suggest that colonoscopy may exacerbate inflammatory bowel disease (IBD) symptoms. Thus, our study aimed to determine risk of emergency room (ER) visits associated with colonoscopy among IBD patients and evaluate potential modifiers of this risk. METHODS The study population included IBD patients in the Multi-Payer Claims Database who were >20 years old and had a colonoscopy from 2007-2010. We used a self-controlled risk interval design and mixed-effects Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI) comparing the incidence of ER visits in the 1-4 weeks following colonoscopy (risk interval) to the incidence of ER visits in the 7-10 weeks after colonoscopy (control interval). We also conducted stratified analyses by patient characteristics, bowel preparation type, and medication. RESULTS There were 212,205 IBD patients with at least 1 colonoscopy from 2007-2010, and 3,699 had an ER visit during the risk and/or control interval. The risk of an ER visit was higher in the 4-week risk interval following colonoscopy compared to the control interval (RR = 1.24; 95% CI: 1.17-1.32). The effect was strongest in those <41 years old (RR = 1.60; 95% CI: 1.21-2.11), in women (RR = 1.32; 95% CI: 1.21-1.44), and in those with sodium phosphate bowel preparation (RR = 2.09; 95% CI: 1.02-4.29). Patients using immunomodulators had no increased risk of ER visits (RR = 0.75; 95% CI: 0.35-1.59). CONCLUSIONS Our results suggest that there is an increased risk of ER visits following colonoscopy among IBD patients, but that immunomodulators and mild bowel preparation agents may mitigate this risk.
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Affiliation(s)
- Andrea N. Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States of America
- School of Public Health, University of Washington, Seattle, Washington, United States of America
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- * E-mail:
| | - Xinwei Hua
- School of Public Health, University of Washington, Seattle, Washington, United States of America
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Tessa C. Rue
- School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Negar Golchin
- School of Pharmacy, University of Washington, Seattle, Washington, United States of America
| | - Larry Kessler
- School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Ali Rowhani-Rahbar
- School of Public Health, University of Washington, Seattle, Washington, United States of America
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23
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Flynn AD, Valentine JF. Chromoendoscopy for Dysplasia Surveillance in Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:1440-1452. [PMID: 29668929 DOI: 10.1093/ibd/izy043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Indexed: 02/07/2023]
Abstract
Long-standing ulcerative colitis (UC) and extensive Crohn's colitis confer increased risk for development of colorectal cancer. Screening and surveillance colonoscopy programs aim to identify, resect, or detect dysplasia or colorectal cancer. Dysplastic lesions can be removed by endoscopic resection and patients with unresectable lesions can be referred for colectomy at an earlier stage, with the goal of reducing overall morbidity and mortality from colorectal cancer. Surveillance colonoscopy for patients with inflammatory bowel disease (IBD) is endorsed by multiple specialty societies. High-definition endoscopy systems provide improved image resolution, and application of dilute indigo carmine or methylene blue for chromoendoscopy can provide increased contrast. International specialty society guidelines differ in their recommendations regarding use of chromoendoscopy for dysplasia surveillance, with some guidelines advocating a risk-stratified surveillance strategy. In this review, we discuss chromoendoscopy technique, training, implementation, yield as compared with standard-definition and high-definition white light colonoscopy, and positioning of this technique in clinical practice.
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Affiliation(s)
- Ann D Flynn
- University of Utah, Division of Gastroenterology, Hepatology, and Nutrition, Salt Lake City, UT
| | - John F Valentine
- University of Utah, Division of Gastroenterology, Hepatology, and Nutrition, Salt Lake City, UT
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24
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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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Bezzio C, Andreozzi P, Casini V, Manes G, Saibeni S. Endoscopy for patients affected by inflammatory bowel disease: bowel preparation and sedation. Expert Rev Gastroenterol Hepatol 2018; 12:119-124. [PMID: 29019424 DOI: 10.1080/17474124.2017.1390430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Endoscopy has a key role in the management of inflammatory bowel disease (IBD). It is helpful in the diagnosis, in case of relapse, refractoriness, before therapeutic changes, after surgery as well as in the assessment of mucosal healing and in the surveillance of colo-rectal cancer. IBD patients are intended to undergo several times the examination during their lifespan. Bowel preparation and sedation highly contribute to high-quality colonoscopy. Areas covered: Few studies addressed preparation and sedation in the field of IBD. In this review, we focused our attention on the available evidences about bowel preparation and sedation in patients with IBD. Expert commentary: In recent years, the goal of medical treatment in IBD is shifting from clinical improvement in symptoms towards mucosal healing. High-quality endoscopy will gain even more importance in the management of IBD. It is important to locate the most effective preparation and the best sedation in patient with IBD to perform a high-quality endoscopy.
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Affiliation(s)
- Cristina Bezzio
- a Gastroenterology Unit , Rho Hospital, ASST Rhodense , Garbagnate Milanese (MI) , Italy
| | - Paolo Andreozzi
- a Gastroenterology Unit , Rho Hospital, ASST Rhodense , Garbagnate Milanese (MI) , Italy
| | | | - Gianpiero Manes
- a Gastroenterology Unit , Rho Hospital, ASST Rhodense , Garbagnate Milanese (MI) , Italy
| | - Simone Saibeni
- a Gastroenterology Unit , Rho Hospital, ASST Rhodense , Garbagnate Milanese (MI) , Italy
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26
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Cole EB, Shah Y, McLean LP, Yang YX, Khan N. Frequency of Surveillance and Impact of Surveillance Colonoscopies in Patients With Ulcerative Colitis Who Developed Colorectal Cancer. Clin Colorectal Cancer 2018; 17:e289-e292. [PMID: 29398423 DOI: 10.1016/j.clcc.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 12/19/2017] [Accepted: 01/09/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The risk of developing colorectal cancer (CRC) in patients with chronic ulcerative colitis (UC) is increased. The aim of this study was to evaluate if patients who developed CRC in the setting of UC were undergoing guideline-recommended surveillance colonoscopies and to determine the impact of surveillance on the staging of CRC. PATIENTS AND METHODS Data was obtained from the Veterans Affairs healthcare system to identify patients with UC and CRC. Stage 0 and I were considered early-stage CRC, whereas stage ≥ II were considered advanced-stage CRC. Patients were considered to have adequate surveillance if they had a colonoscopy within 2 years before developing CRC. We conducted a case-case analysis using multivariable logistic regression to estimate the odds ratio for presenting with advanced-stage CRC associated with lack of adequate surveillance. RESULTS Of the 48 patients, the majority were white (70.8%) and male (100%). Sixty-nine percent of patients had inadequate surveillance. In multivariable analysis, prior adherence to CRC surveillance was associated with a decreased risk of presenting with advanced-stage CRC (vs. early-stage CRC) (adjusted odds ratio, 0.20; 95% confidence interval, 0.05-0.85; P = .029). CONCLUSION The majority of patients who developed CRC in the setting of UC underwent inadequate surveillance, and they were more likely to present with advanced-stage CRC.
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Affiliation(s)
- Elisabeth B Cole
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Yash Shah
- Section of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Leon P McLean
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland Baltimore, Baltimore, MD
| | - Yu-Xiao Yang
- Section of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA; Section of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Nabeel Khan
- Section of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA; Section of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Kim ES, Kim KO, Jang BI, Kim EY, Lee YJ, Lee HS, Jeon SW, Kim HJ, Kim SK. Comparison of 4-L Polyethylene Glycol and 2-L Polyethylene Glycol Plus Ascorbic Acid in Patients with Inactive Ulcerative Colitis. Dig Dis Sci 2017. [PMID: 28639128 DOI: 10.1007/s10620-017-4634-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although colonoscopy preparation may cause symptom flares in patients with ulcerative colitis (UC), little is known about the standard preparation regimen in this population. AIM We aimed to compare 4L polyethylene glycol (4L-PEG) with 2L polyethylene glycol plus ascorbic acid (2L-PEG-Asc) in quiescent UC patients. METHODS Patients with inactive UC undergoing colonoscopy for surveillance or checkup of mucosal healing were prospectively enrolled at 5 tertiary hospitals. They were randomly assigned to 4L-PEG and 2L-PEG-Asc groups. The Boston Bowel Preparation Scale (BBPS) was used for the preparation quality. Symptoms were assessed using the Simple Clinical Colitis Activity Index (SCCAI) before colonoscopy, at 1 and 4 weeks after the procedure. RESULTS Overall, 109 patients were included in the study (4L-PEG group 53, 2L-PEG-Asc group 56, the mean age at diagnosis 42.25 years, male 77). The quality of preparation was comparable between the groups (BBPS ≥ 6, 96.2 vs. 92.9%, p = 0.679). Although 26 patients (23.8%) had increased SCCAI scores within 4 weeks after colonoscopy, resulting in a medication dose-up or add-on in 3 patients (2.7%), the rise in scores was not different between the groups. No serious adverse events during preparation were observed in either group. However, the 2L-PEG-Asc group was more likely to be willing to repeat the preparation with the same agent than the 4L-PEG group (82.1 vs. 64.2%, respectively, p = 0.034). CONCLUSION PEG-based regimens with different volumes are equally effective and safe in inactive UC patients. 2L-PEG-Asc is more acceptable in this population as indicated by the willingness for further usage.
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Affiliation(s)
- Eun Soo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721, Korea
| | - Kyeong Ok Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Byung Ik Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Young Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Yoo Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun Seok Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721, Korea
| | - Seong Woo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721, Korea
| | - Hyun Jin Kim
- Division of Gastroenterology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Sung Kook Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721, Korea.
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Senore C, Bellisario C, Hassan C. Organization of surveillance in GI practice. Best Pract Res Clin Gastroenterol 2016; 30:855-866. [PMID: 27938781 DOI: 10.1016/j.bpg.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/07/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several reports documented an inefficient utilisation of available resources, as well as a suboptimal compliance with surveillance recommendations. Although, evidence suggests that organisational issues can influence the quality of care delivered, surveillance protocols are usually based on non-organized approaches. METHODS We conducted a literature search (publication date: 01/2000-06/2016) on PubMed and Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Cochrane Central Register of Controlled Trials for guidelines, or consensus statements, for surveys of practice, reporting information about patients, or providers attitudes and behaviours, for intervention studies to enhance compliance with guidelines. Related articles were also scrutinised. Based on the clinical relevance and burden on endoscopy services this review was focused on surveillance for Barrett's oesophagus, IBD and post-polypectomy surveillance of colonic adenomas. RESULTS Existing guidelines are generally recognising structure and process requirements influencing delivery of surveillance interventions, while less attention had been devoted to transitions and interfaces in the care process. Available evidence from practice surveys is suggesting the need to design organizational strategies aimed to enable patients to attend and providers to deliver timely and appropriate care. Well designed studies assessing the effectiveness of specific interventions in this setting are however lacking. Indirect evidence from screening settings would suggest that the implementation of automated standardized recall systems, utilisation of clinical registries, removing financial barriers, could improve appropriateness of use and compliance with recommendations. CONCLUSIONS Lack of sound evidence regarding utility and methodology of surveillance can contribute to explain the observed variability in providers and patients attitudes and in compliance with the recommended surveillance.
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Affiliation(s)
- Carlo Senore
- SC Epidemiologia, Screening, Registro Tumori - CPO, AOU Città della Salute e della Scienza, Torino, Italy.
| | - Cristina Bellisario
- SC Epidemiologia, Screening, Registro Tumori - CPO, AOU Città della Salute e della Scienza, Torino, Italy
| | - Cesare Hassan
- Servizio di Gastroenterologia, Ospedale Nuovo Regina Margherita, Roma, Italy
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Herman ML, Kane SV. Treatment Nonadherence in Inflammatory Bowel Disease: Identification, Scope, and Management Strategies. Inflamm Bowel Dis 2015; 21:2979-2984. [PMID: 26355470 DOI: 10.1097/mib.0000000000000581] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Treatment adherence is of critical importance in the management of patients with IBD. Poor adherence can lead to increased disease activity, loss of response to therapy, and increased costs of care. It has been well established that adherence to long-term therapy for chronic illnesses is extremely poor, averaging around 50% in developed countries. Measured rates of nonadherence in IBD are similar, but vary depending on the type of therapy and the population being observed. This article reviews the scientific data on treatment nonadherence in IBD. The methods commonly used to evaluate treatment adherence investigation are reviewed. The consequences and scope of treatment nonadherence are summarized. Finally, the scientific data on management strategies to address the problem of treatment nonadherence are explored.
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Affiliation(s)
- Margot L Herman
- *Division of Gastroenterology and Hepatology, University of Washington, Seattle, Washington; and †Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota
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Colon Cleansing for Colonoscopy in Patients with Ulcerative Colitis: Efficacy and Acceptability of a 2-L PEG Plus Bisacodyl Versus 4-L PEG. Inflamm Bowel Dis 2015; 21:2137-44. [PMID: 26164666 DOI: 10.1097/mib.0000000000000463] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Low-volume preparations are gaining attention for higher acceptability but have been never evaluated in IBD. We compare the efficacy, safety, and tolerability of a 2-L PEG with a 4-L PEG solution in patients with ulcerative colitis. METHODS This is a multicenter, randomized, single-blind study. Adult outpatients with ulcerative colitis undergoing colonoscopy received either 2-L PEG plus bisacodyl or 4-L PEG. Bowel cleansing was assessed using the Ottawa Scale and rated as adequate if the score was ≤2 in each colon segment. Patient acceptance, satisfaction, and related symptoms were recorded. RESULTS Preparation was adequate in 80% of the 211 patients without any differences between groups. Mean Ottawa scores for whole and right colon were similar in the 2 groups. As concern tolerability, 83% patients in 2-L PEG arm and 44.8% in 4-L PEG arm reported no or mild discomfort (P < 0.0001) and 94.3% and 61.9% expressed their willingness to repeat the preparation (P < 0.001). Palatability was better with 2-L PEG, whereas related symptoms occurred more frequently with 4-L PEG. Regardless of preparation, split dosage was associated with better cleansing. Further predictors of poor cleansing were moderate/severe discomfort during preparation and more than 6 hours between end of preparation and colonoscopy. Extension and severity of colitis did not influence quality of preparation. CONCLUSIONS Low-volume PEG is not inferior to 4-L PEG for bowel cleansing in ulcerative colitis, but it is better tolerated and accepted. The time interval from solution intake and colonoscopy is the most important factor affecting quality of cleansing in ulcerative colitis.
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Stiles-Shields C, Keefer L. Web-based interventions for ulcerative colitis and Crohn's disease: systematic review and future directions. Clin Exp Gastroenterol 2015; 8:149-57. [PMID: 26005356 PMCID: PMC4433044 DOI: 10.2147/ceg.s56069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Behavioral intervention technologies (BITs), the application of psychological and behavioral interventions through the use of technology, provide the opportunity for clinicians to deliver care through a means that overcomes a number of treatment barriers. Web-based interventions are a subset of BITs developing as promising alternatives to face-to-face delivery of treatments and monitoring for patients with ulcerative colitis (UC) and Crohn’s disease (CD). A systematic review of literature resulted in five empirical studies of web-based interventions for UC and CD. Additionally, an informal search of a popular search engine yielded limited, currently available, web-based interventions for patients with UC and CD. Despite being an ideal population for the development and dissemination of online interventions, patients with UC and CD have far less treatment options compared to other behavioral health concerns. However, given the growing body of research involving web-based interventions for other conditions, researchers and clinicians targeting UC and CD management and treatment have the benefit of being able to utilize the BIT model, an existing conceptual framework for the development of web-based interventions for both conditions. The BIT model is presented and applied to the treatment of UC and CD, as well as a technology development program, Purple, and usability guidelines to guide clinical researchers in the future development, evaluation, and dissemination of BITs for patients with UC and CD.
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Affiliation(s)
- Colleen Stiles-Shields
- Department of Preventive Medicine and Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laurie Keefer
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA ; Center for Psychosocial Research in GI, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kurada S, Alkhouri N, Fiocchi C, Dweik R, Rieder F. Review article: breath analysis in inflammatory bowel diseases. Aliment Pharmacol Ther 2015; 41:329-41. [PMID: 25523187 DOI: 10.1111/apt.13050] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 05/15/2014] [Accepted: 11/21/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is an urgent need for cheap, reproducible, easy to perform and specific biomarkers for diagnosis, differentiation and stratification of inflammatory bowel disease (IBD) patients. Technical advances allow for the determination of volatile organic compounds in the human breath to differentiate between health and disease. AIM Review and discuss medical literature on volatile organic compounds in exhaled human breath in GI disorders, focusing on diagnosis and differentiation of IBD. METHODS A systematic search in PubMed, Ovid Medline and Scopus was completed using appropriate keywords. In addition, a bibliography search of each article was performed. RESULTS Mean breath pentane, ethane, propane, 1-octene, 3-methylhexane, 1-decene and NO levels were elevated (P < 0.05 to P < 10(-7)) and mean breath 1-nonene, (E)-2-nonene, hydrogen sulphide and methane were decreased in IBD compared to healthy controls (P = 0.003 to P < 0.001). A combined panel of 3 volatile organic compounds (octene, (E)-2-nonene and decene) showed the best discrimination between paediatric IBD and controls (AUC 0.96). Breath condensate cytokines were higher in IBD compared to healthy individuals (P < 0.008). Breath pentane, ethane, propane, isoprene and NO levels correlated with disease activity in IBD patients. Breath condensate interleukin-1β showed an inverse relation with clinical disease activity. CONCLUSIONS Breath analysis in IBD is a promising approach that is not yet ready for routine clinical use, but data from other gastrointestinal diseases suggest the feasibility for use of this technology in clinical practice. Well-designed future trials, incorporating the latest breath detection techniques, need to determine the exact breath metabolome pattern linked to diagnosis and phenotype of IBD.
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Affiliation(s)
- S Kurada
- Department of Hospital Medicine, Medicine Institute, Cleveland, OH, USA
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Ananthakrishnan AN, Cagan A, Cai T, Gainer VS, Shaw SY, Churchill S, Karlson EW, Murphy SN, Kohane I, Liao KP. Colonoscopy is associated with a reduced risk for colon cancer and mortality in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2015; 13:322-329.e1. [PMID: 25041865 PMCID: PMC4297589 DOI: 10.1016/j.cgh.2014.07.018] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/02/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Crohn's disease and ulcerative colitis are associated with an increased risk of colorectal cancer (CRC). Surveillance colonoscopy is recommended at 2- to 3-year intervals beginning 8 years after diagnosis of inflammatory bowel disease (IBD). However, there have been no reports of whether colonoscopy examination reduces the risk for CRC in patients with IBD. METHODS In a retrospective study, we analyzed data from 6823 patients with IBD (2764 with a recent colonoscopy, 4059 without a recent colonoscopy) seen and followed up for at least 3 years at 2 tertiary referral hospitals in Boston, Massachusetts. The primary outcome was diagnosis of CRC. We examined the proportion of patients undergoing a colonoscopy within 36 months before a diagnosis of CRC or at the end of the follow-up period, excluding colonoscopies performed within 6 months before a diagnosis of CRC, to avoid inclusion of prevalent cancers. Multivariate logistic regression was performed, adjusting for plausible confounders. RESULTS A total of 154 patients developed CRC. The incidence of CRC among patients without a recent colonoscopy (2.7%) was significantly higher than among patients with a recent colonoscopy (1.6%) (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.39-0.80). This difference persisted in multivariate analysis (OR, 0.65; 95% CI, 0.45-0.93) and was robust when adjusted for a range of assumptions in sensitivity analyses. Among patients with CRC, a colonoscopy within 6 to 36 months before diagnosis was associated with a reduced mortality rate (OR, 0.34; 95% CI, 0.12-0.95). CONCLUSIONS Recent colonoscopy (within 36 months) is associated with a reduced incidence of CRC in patients with IBD, and lower mortality rates in those diagnosed with CRC.
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Affiliation(s)
- Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
| | - Andrew Cagan
- Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts
| | - Tianxi Cai
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Vivian S Gainer
- Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts
| | - Stanley Y Shaw
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Susanne Churchill
- i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth W Karlson
- Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Shawn N Murphy
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Isaac Kohane
- Harvard Medical School, Boston, Massachusetts; i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts; Children's Hospital Boston, Boston, Massachusetts
| | - Katherine P Liao
- Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts
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Parra-Blanco A, Ruiz A, Alvarez-Lobos M, Amorós A, Gana JC, Ibáñez P, Ono A, Fujii T. Achieving the best bowel preparation for colonoscopy. World J Gastroenterol 2014; 20:17709-17726. [PMID: 25548470 PMCID: PMC4273122 DOI: 10.3748/wjg.v20.i47.17709] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 07/20/2014] [Accepted: 11/08/2014] [Indexed: 02/06/2023] Open
Abstract
Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here.
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Friedman S, Cheifetz AS, Farraye FA, Banks PA, Makrauer FL, Burakoff R, Farmer B, Torgersen LN, Wahl KE. High self-efficacy predicts adherence to surveillance colonoscopy in inflammatory bowel disease. Inflamm Bowel Dis 2014; 20:1602-1610. [PMID: 25033161 DOI: 10.1097/mib.0000000000000125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with extensive ulcerative colitis or Crohn's disease of the colon have an increased risk of colon cancer and require colonoscopic surveillance. In this study, we assessed individual self-efficacy (SE) to estimate the probability of adherence to surveillance colonoscopies. METHODS Three hundred seventy-eight patients with ulcerative colitis or Crohn's disease of the colon for at least 7 years and with at least one third of the colon involved participated in this cross-sectional questionnaire study performed at 3 tertiary referral inflammatory bowel disease clinics. Medical charts were abstracted for demographic and clinical variables. The questionnaire contained a group of items assessing SE for undergoing colonoscopy. RESULTS We validated our 20-question SE scale and used 8 of the items that highlighted scheduling, preparation, and postprocedure recovery, to develop 2 shorter SE scales. All 3 scales were reliable with Cronbach's α ranging from 0.845 to 0.905 and correlated with chart-documented adherence to surveillance colonoscopy (P < 0.001). We then developed logistic regression models to predict adherence to surveillance colonoscopy using each scale separately along with other key variables (i.e., disease location, knowledge of correct adherence intervals, and information sources of patients consulted regarding Crohn's disease and ulcerative colitis) and demonstrated model accuracy up to 74%. CONCLUSIONS SE, as measured by our validated scales, correlates with chart-adherence to surveillance colonoscopy. Our adherence model, which includes SE, predicts adherence with 74% certainty. An 8-item validated clinical questionnaire can be administered to assess whether patients in this population may require further intervention for adherence.
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Affiliation(s)
- Sonia Friedman
- *Department of Medicine, Division of Gastroenterology, Brigham and Women's Hospital; †Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center; ‡Department of Medicine, Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts; and §Department of Analysis and Information Management, University of California, Los Angeles, California
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Nett A, Velayos F, McQuaid K. Quality bowel preparation for surveillance colonoscopy in patients with inflammatory bowel disease is a must. Gastrointest Endosc Clin N Am 2014; 24:379-92. [PMID: 24975529 DOI: 10.1016/j.giec.2014.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colonoscopy is routinely performed in patients with inflammatory bowel disease (IBD) for surveillance of dysplasia. Thorough bowel preparation is necessary to facilitate lesion detection. Patients with IBD do not have poorer bowel preparation outcomes but may have decreased preparation tolerance affecting adherence to surveillance protocols. A low-fiber prepreparation diet may improve preparation tolerance without affecting preparation quality. The standard preparation regimen should consist of split-dose administration of a polyethylene glycol-based purgative. Low-volume, hyperosmolar purgatives may be considered in patients with previous preparation intolerance, heightened anxiety, stenotic disease, or dysmotility. Appropriate patient education is critical to enhance preparation quality.
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Affiliation(s)
- Andrew Nett
- Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143, USA
| | - Fernando Velayos
- Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143, USA
| | - Kenneth McQuaid
- Department of Medicine, San Francisco VA Medical Center, University of California, San Francisco, 4150 Clement Street, Room 111-B, San Francisco, CA 94121, USA.
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Are inflammatory bowel disease patients undergoing surveillance colonoscopies at the recommended time? Inflamm Bowel Dis 2013; 19:E82-3. [PMID: 23917249 DOI: 10.1097/mib.0b013e31829ed8e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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"Doctor, I just can't": nonadherence to surveillance colonoscopy. Inflamm Bowel Dis 2013; 19:540-1. [PMID: 23429445 DOI: 10.1097/mib.0b013e318281ce80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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