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PubMed1996

Comparison of oral sodium phosphate to polyethylene glycol-based solution for bowel preparation for colonoscopy in children.

Thirty-four patients, aged 3 to 17 years, were randomized to receive oral sodium phosphate solution or a polyethylene glycol-based solution in preparation for elective colonoscopy. Nineteen patients received two doses of oral sodium phosphate solution (45 mL/1.7 m2/ dose) and 15 received polyethylene glycol-based solution (4 L/1.7 m2). Compliance with oral sodium phosphate solution was judged as easy or tolerable in 15 of 19 patients, but only in 5 of 15 who were given polyethylene glycol-based solution. The quality of colon cleansing was rated by an endoscopist who was blinded to the colon preparation method used. The bowel preparation was excellent or good (only liquid remaining in the colonic lumen) in 18 of 19 patients who received oral sodium phosphate solution and in 6 of 15 who received polyethylene glycol-based solution. The incidence of vomiting was similar in both groups, but abdominal pain occurred more frequently in the polyethylene glycol-based solution group. Hyperphosphatemia developed in patients who received oral sodium phosphate solution (serum phosphorus = 2.3 +/- 0.7 mmol/L (7.2 +/- 2.2 mg/dL; mean +/- SD), but only in 1 of 15 patients in the polyethylene glycol-based solution group. Patients did not exhibit symptoms of hyperphosphatemia and serum calcium concentrations were similar in both groups. In summary, oral sodium phosphate solution is better tolerated than polyethylene glycol-based solution for bowel preparation in children. However, hyperphosphatemia occurred frequently in patients who received oral sodium phosphate solution. Further studies are needed to determine the optimal dose for safety and efficacy for the use of these solutions in children.

Adolescent↗
PubMed1985

Colonoscopy and the barium enema: a radiologic viewpoint.

Adherents of colonoscopy are recommending that it replace the radiologic examination as the initial diagnostic study of the colon. We present the radiologic view, supporting the barium enema as a more practical approach to initial diagnostic evaluation. The radiologic examination is an equally reliable, less costly, and much safer method for detecting colonic disease.

Barium Sulfate↗
PubMed1999

Interactive 3-D virtual colonoscopy system.

We describe a low-cost three-dimensional (3-D) virtual colonoscopy system that is a noninvasive technique for examining the entire colon and can assist physicians in detecting polyps inside the colon. Using the helical CT data and proposed techniques, we can three-dimensionally reconstruct and visualize the inner surface of the colon. We generate high resolution of video views of the colon interior structures as if the viewer's eyes were inside the colon. The physicians can virtually navigate inside the colon in two different modes: interactive and automatic navigation, respectively. For automatic navigation, the flythrough path is determined a priori using the 3-D thinning and two-pass tracking schemes. The whole colon is spatially subdivided into several cells, and only potentially visible cells are taken into account during rendering. To further improve rendering efficiency, potentially visible cells are rendered at different levels of detail. Additionally, a chain of bounding volume in each cell is used to avoid penetrating through the colon during navigation. In comparison with previous work, the proposed system can efficiently accomplish required preprocessing tasks and afford adequate rendering speeds on a low-cost PC system.

Automation↗
PubMed1993

Efficacy and tolerability of polyethylene glycol-electrolyte lavage solution with and without simethicone in the preparation of patients with inflammatory bowel disease for colonoscopy.

This placebo-controlled study assessed the efficacy and tolerability of polyethylene glycol-electrolyte lavage solution (PEG-ELS), with and without simethicone, in the preparation of patients with inflammatory bowel disease for colonoscopy. PEG-ELS 4 L plus placebo, or PEG-ELS 4 L plus simethicone 120 mg. was administered according to a randomized double-blind protocol to 115 patients with ulcerative colitis or Crohn's disease. The parameters assessed were: presence of bubbles, degree of haziness, degree of bowel cleansing and patient acceptance. In the 105 patients completing the study, the efficacy of colonic lavage was found to be essentially comparable for the two preparations, although the addition of simethicone showed a significant reduction in the formation of bubbles. Significantly better results were reported by patients treated with the drug combination regarding reduction of general malaise (P = 0.01) and sleep disturbance (P = 0.01). The PEG-ELS solution represents an effective bowel cleansing method which can also be used for patients suffering from inflammatory bowel disease. The addition of simethicone to the traditional formulation is an acceptable development in terms of clinical efficacy and tolerability.

Adult↗
PubMed1994

Review article: orthograde gut lavage for colonoscopy.

Most colon cleansing regimens for surgical and diagnostic procedures such as colonoscopy are modifications of older barium enema X-ray preparations which have evolved in gastrointestinal laboratories influenced by empiric experience. Recent formal study allows for careful comparison of gut lavage, diet and cathartic, and oral sodium phosphate preparations. This review will evaluate oral lavage solutions and address their safety, tolerance and efficacy. Administration options are discussed as well as other diet and cathartic methods previously referred to as 'standard preps'.

Administration, Oral↗
PubMed2006

Effect-site targeted patient-controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy.

Patient-controlled sedation (PCS) allows patients to match their sedation requirement to perceived discomfort. The significant delay in onset of sedation may be overcome with effect-site steered target controlled infusion, but previously only trials in volunteers have been carried out. We therefore conducted a randomised, double-blind controlled trial comparing effect-site steered propofol PCS with anaesthetist-administered propofol sedation in 40 patients presenting for colonoscopy. The initial effect-site target in the PCS group was 0.8 microg.ml(-1), increment was 0.1 microg.ml(-1) and lockout was 3 min. Patient and endoscopist satisfaction and operating conditions were similar between the two groups. PCS patients were sedated more slowly (13 [7.1] vs. 3 [1.1] min; p < 0.0001) and less deeply (minimum BIS value: 71 [16] vs. 58 [15]; p = 0.13) than anaesthetist-administered propofol sedation patients. More of the latter patients were hypotensive, but all patients had similar recollection of events during the procedure and similar quality of recovery.

Adolescent↗
PubMed2005

Role of aberrant crypt foci detected using high-magnification-chromoscopic colonoscopy in human colorectal carcinogenesis.

Abstract Liaison between gastrointestinal endoscopists and histopathologists is essential to provide the highest standards of diagnostic accuracy and patient management. The histopathologist needs to be aware of the endoscopic findings when interpreting endoscopic biopsies. High-magnification-chromoscopic-colonoscopy (HMCC) is a new technology that provides the endoscopists with much greater resolution and functional staining of the gastrointestinal tract. Using HMCC, the endoscopist is now able to identify subtle changes in the colorectal luminal openings or crypts. Changes in crypt appearances now allow detection of aberrant crypt foci (ACF) in the colon, which might themselves be precancerous lesions but additionally might serve as a valid biomarker of subsequent adenoma and colorectal cancer formation. This article describes the role of the aberrant crypt focus in colorectal carcinogenesis and discusses the clinical impact of HMCC techniques as applicable to ACF.

Cell Transformation, Neoplastic↗
PubMed1990

Hypoxia and hypotension during endoscopy and colonoscopy.

Sixty-three patients undergoing oesophagogastroduodenoscopy (OGD) (n = 24) or proctosigmoidocolonoscopy (PSC) (n = 39) had continuous monitoring of arterial oxygen saturation (SaO2), pulse and mean blood pressure (BP). The degree of patient distress, duration, dose of sedative and details of the endoscope and operator were recorded. Marked hypotensive (greater than 40% fall in BP) and hypoxic (greater than 8% fall in SaO2) changes occurred in 13% and 17% of the overall group, respectively. There were no significant differences in fall in BP, SaO2 or pulse between the OGD and PSC groups. The dose of sedative was significantly related to the fall in SaO2 (P less than 0.001) but not to the fall in BP. The falls in both SaO2 and BP were related to the duration of the procedure (P less than 0.001, P = 0.03, respectively). There were no correlations between the degree of hypoxia or hypotension and the patient's age or previous medical history. Hypotension and hypoxia occur in both colonoscopy and OGD and are neither predictable nor usually recognizable clinically. Pulse oximetric and BP monitoring throughout gastrointestinal endoscopy are recommended for maximal safety.

Adult↗
PubMed2005

Impact of the Cancer Risk Intake System on patient-clinician discussions of tamoxifen, genetic counseling, and colonoscopy.

The Cancer Risk Intake System (CRIS), a computerized program that "matches" objective cancer risks to appropriate risk management recommendations, was designed to facilitate patient-clinician discussion. We evaluated CRIS in primary care settings via a single-group, self-report, pretest-posttest design. Participants completed baseline telephone surveys, used CRIS during clinic visits, and completed follow-up surveys 1 to 2 months postvisit. Compared with proportions reporting having had discussions at baseline, significantly greater proportions of participants reported having discussed tamoxifen, genetic counseling, and colonoscopy, as appropriate, after using CRIS. Most (79%) reported CRIS had "caused" their discussion. CRIS is an easily used, disseminable program that showed promising results in primary care settings.

Adult↗
PubMed1999

A randomized, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children.

OBJECTIVE: We performed a prospective, randomized, single-blind study in children undergoing colonoscopy to evaluate the acceptance and efficacy of three different bowel preparations. METHODS: Seventy patients (ages 3-20 yr, 38 males) were randomly assigned to one of the three study preparations: Magnesium citrate with X-prep and clear liquid diet for 2 days (group A); Dulcolax for 2 days and Fleet enema without dietary restriction (group B); and Golytely 20 ml/kg (up to 1 L) per hour for 4 h with clear liquid diet for 1 day (group C). Endoscopists blinded to bowel preparation graded the adequacy of colon cleansing. The preparations were rated by patients for tolerance, willingness to retake them, adverse effects, and compliance. RESULTS: Data analysis using Fisher exact test and trend test showed that colon cleansing in groups A and C was superior to that in group B (p < 0.0001) and better in group C than A (p < 0.075). Overall tolerance and compliance were significantly better for groups A and B than group C (p < 0.003), but not different between A and B. More of group B patients were willing to retake the preparation than in group C (p < 0.002) and group A (p < 0.05), but this was not different between groups A and C. Adverse effects were reported more frequently by patients in group C than in groups A and B (p < 0.01). CONCLUSIONS: Although the least well tolerated, Golytely provided the best cleansing. Dulcolax without dietary restriction provided unsatisfactory colon cleansing. Magnesium citrate with X-prep was acceptable and provided good cleansing.

Adolescent↗
PubMed2004

Patient-controlled versus nurse-administered sedation with propofol during colonoscopy. A prospective randomized trial.

OBJECTIVES: Patient-controlled sedation (PCS) with propofol, is well tolerated and reduces recovery time and staff required during endoscopic interventions. "Who" administers the drug proves economically crucial. With the aim of maintaining safety, medical quality, and patient satisfaction, this study investigates PCS versus nurse-administered propofol sedation (NAPS) in a cohort of consecutive patients. METHODS: One hundred and fourteen patients, aged 22-90 yr, undergoing only colonoscopy participated in this prospective randomized trial. Patients were randomly assigned to either PCS or NAPS. If patients declined randomization for different reasons of reluctance to PCS they were assigned to a standard nurse-sedated control group. All patients received pethidine presedation for analgesia. Visual analogue scales followed patient anxiety level, tolerability, pain, and satisfaction, and endoscopist's assessment of the procedure. RESULTS: Given the choice, 35% of the patients who were rather younger and more anxious declined randomization to PCS. The mean total dose of propofol needed in this group was higher, but the patients had a tendency to rate the global tolerance and the pain of the examination as less comfortable compared to the two randomized groups. Self-administration of propofol created a significantly different drug profile and higher medication costs. With regard to the safety parameters there was no difference between PCS and NAPS. In their global assessments, the patients and endoscopists tended to prefer NAPS. CONCLUSIONS: Individual patient characteristics and attitudes toward self-control are crucial for PCS. While being a viable option for patients who are able and willing to handle, this technique is not applicable in a considerable portion of everyday patients.

Adult↗
PubMed2005

Effectiveness of walking exercise as a bowel preparation for colonoscopy: a randomized controlled trial.

OBJECTIVES: This prospective study was conducted to assess the effect of walking exercise on bowel cleansing before colonoscopy and to define a patient subgroup that would benefit from walking exercise. METHODS: A total of 383 outpatients were randomized into two groups (G1 [n = 196]; walking exercise, G2 [n = 187]; nonexercise). Those randomized to G1 were instructed to drink 250 mL of polyethylene glycol (PEG) solution and then walk at least for 5 min at intervals of 10 min whereas those randomized to G2 were instructed to drink and then take rest in a waiting room until the entire 2.5-3 L volume was consumed. The amount of walking exercise in both groups was estimated using a step counter. A single endoscopist estimated the efficacy of cleansing in a single-blinded manner. Patient's demographics, various parameters related to bowel preparation, and the degree of patients discomfort caused by the walking exercise were assessed. RESULTS: The number of step counts taken was significantly different for the two groups (p < 0.001). The degree of bowel cleansing in the G1 (n = 189) and G2 (n = 177) groups was significantly different (p < 0.01). However, the groups were similar in terms of all other data collected. By univariate analysis, walking exercise was especially beneficial to a subgroup of nonobese patients of age <65 yr, without history of abdominal surgery. Also, multivariate logistic regression analysis demonstrated that nonexercise (OR = 0.49; 95% CI = 0.31-0.79) was an independent risk factor for poor bowel cleansing. Most walking patients (97.3%) considered walking exercise more comfortable than taking the polyethylene glycol solution. CONCLUSION: The walking exercise was found to improve colonoscopic bowel cleansing without significant patient discomfort.

Adult↗
PubMed2006

Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy.

BACKGROUND: Propofol by nonanesthesiologists is controversial because the drug is commonly used to produce deep sedation or general anesthesia. Propofol in combination with opioids and/or benzodiazepines can be titrated to moderate sedation, which might be safer. AIM: To compare recovery time, patient satisfaction, and other end points with propofol alone titrated to deep sedation versus propofol combination therapy with opioids and/or benzodiazepines. METHOD: A randomized controlled clinical trial of propofol alone titrated to deep sedation versus fentanyl plus propofol versus midazolam plus propofol versus fentanyl plus midazolam plus propofol in 200 outpatients undergoing colonoscopy. Each combination regimen was titrated to moderate sedation. RESULTS: Patients receiving propofol alone received higher doses of propofol and had deeper sedation scores compared with combination therapy (both p < 0.001). Patients receiving combination regimens were discharged more quickly (median 13.0-14.7 versus 18.1 min) than those receiving propofol alone (p < 0.01). There were no differences in vital signs or oxygen saturations among the study arms. There were no significant differences in pain or satisfaction among the study arms in the recovery area. At a follow-up phone call, patients receiving fentanyl and propofol remembered more of the procedure than those in the other regimens (p < 0.005) and remembered more pain than those receiving propofol alone (p < 0.02). CONCLUSIONS: Propofol in combination with fentanyl and/or midazolam can be titrated to moderate levels of sedation without substantial loss of satisfaction and with shorter recovery times compared with propofol titrated to deep sedation throughout the procedure.

Adjuvants, Anesthesia↗
PubMed2006

Veillonella parvula discitis and secondary bacteremia: a rare infection complicating endoscopy and colonoscopy?

We report a case of Veillonella parvula lumbar discitis and secondary bacteremia confirmed by molecular characterization of the 16S rRNA genes. Identification of the organism was essential for an appropriate choice of antimicrobial therapy following the failure of empirical flucloxacillin. Veillonella spp. are normal flora of the gastrointestinal tract, raising the possibility that an endoscopy and colonoscopy performed 8 weeks prior to presentation, during which small intestinal and rectal biopsies were obtained, was the portal of entry. This case highlights the importance of obtaining a microbiologic diagnosis, particularly in patients who previously have had procedures involving instrumentation.

Bacteremia↗
PubMed1984

Routine colonoscopy service.

We report our experience of 50 paediatric colonoscopies in a relatively unselected group of patients. Collaboration between an experienced colonoscopist and a paediatrician has provided a smooth, routine service and the examination has proved extremely useful for the diagnosis and management of children with colonic symptoms.

Child↗
PubMed1986

Histological abnormalities in biopsies from macroscopically normal colonoscopies.

One hundred and nineteen children with gastrointestinal symptoms underwent colonoscopy during the course of one year. Out of 39 children that were reported as yielding normal results on endoscopic examination, six had disease detectable only by histology. The pathology included cases of microscopic colitis, Crohn's disease, and indeterminate colitis. To exclude large bowel inflammation as a cause of gastrointestinal symptoms biopsy specimens should always be taken at endoscopy.

Adolescent↗