Boston Scale Research Articles

Improving Colonoscopy Preparation Using Information and Communication Technologies (ICT), Randomized Clinical Trial

Objective: Colonoscopy is a handy tool in preventing and diagnosing colorectal cancer. Its optimal performance requires adequate preparation for good visualization of the mucosa. In our endoscopy unit, we use the Boston scale to evaluate the quality of bowel preparation. The present work intends to assess whether or not an additional intervention with an educational video on the Internet could improve the result of preparation using the Boston scale for colonoscopy to enhance the visualization and detection of adenomas. Methods: A double-masked, randomized clinical trial. One group of patients received printed instructions on colonoscopy preparation, and another group received the same preparation plus the form contained a link and instructions to access and view a colonoscopy video posted on YouTube. Results: A highly significant difference was observed between the means of the Boston preparation score for the group that watched the video versus the group that did not (8.16 vs. 6.75; p < 0.0001). A significant difference was also found in the Boston score by segments of the colon: right (2.6 vs. 1.9; p < 0.001), transverse (2.7 vs. 2.3; p < 0.0001), and left (2.8 vs. 2.5; p < 0.0001). Concerning the adenoma detection rate, it was higher in the group that watched the video (28%) than in the group that did not (21%); however, the difference was not significant (p = 0.33). Conclusion: Watching an educational video significantly improves the quality of colonoscopy preparation through the Boston scale and the detection of adenomas; however, this difference was not significant, possibly due to a lack of a larger sample.

Feasibility and Colonoscopy Yield Using the Fecal Immunochemical Test (FIT)-Based Colorectal Cancer Screening in a Latin America Country

Background and aimsOrganized colorectal cancer (CRC) is not widely practiced in Latin America and the results of regional studies may help overcome barriers for implementation of national screening programs. We aimed to describe the implementation and findings of a fecal immunochemical test (FIT)-based program in Brazil. MethodsIn a prospective population-based study, asymptomatic individuals (50 to 75 years-old) from Sao Paulo city were invited to undergo FIT for CRC screening. Participants with positive FIT (>10 μg Hb/g feces) were referred for colonoscopy. Subjects were classified into groups according to the presence of CRC, precursor lesions, and other benign findings, possibly related to bleeding. ResultsOf a total of 9,881 subjects, 7.8% had positive FIT and colonoscopy compliance was 68.9% (n=535). Boston scale was considered adequate in 99% and cecal intubation rate was 99.4%. CRC was diagnosed in 5.9% of the cases, adenoma in 63.2%, advanced adenoma (AA) in 31.4%, and advanced neoplasia (AN) in 33.0%. Age was positively associated with CRC (p=0.03). Higher FIT concentrations were associated with increased detection of CRC (p<0.008), AA (p<0.001), and AN (p<0.001). ConclusionImplementation of a FIT-based CRC screening program was feasible in a low-resource setting, and there was a high yield for neoplasia in individuals with a positive FIT. This approach could be used as a model to plan and disseminate organized CRC screening more broadly in Brazil and Latin America.

Screening colonoscopy as an effective way to prevent colorectal cancer

Introduction. Colorectal cancer (CRC) is one of those cancer types which have many worldwide organized screening programs. Those screening programs help to reduce colorectal cancer morbidity and mortality. Aim. To evaluate the results of screening colonoscopy with simultaneous removal of benign epithelial formations on an outpatient basis using “cold” methods, as well as its effectiveness in the prevention of CRC. Materials and methods. A retrospective analysis of the results of colonoscopy in outpatient conditions performed at the N. I. Pirogov Government City Clinic (Orenburg) for the period 2018–2021 was performed. The study included indicators of screening colonoscopy performed in asymptomatic patients. The main evaluated parameters are: the type of polyp according to the Paris classification, the results of histological examination, the frequency of complications, as well as the quality indicators of colonoscopy (preparation according to the Boston scale, the time of removal of the device, adenoma detection rate (ADR), polyp detection rate (PDR)). Results. A total of 4,588 screening colonoscopies were performed, frequency of adenomas detection – 35,3 %, 1,041 neoplasms were removed (of which 456 (44 %) neoplasms were removed with biopsy forceps, 585 (56 %) neoplasms were removed with a cold loop as a single block). In 622 (59,7 %) cases, the macroscopic form of neoplasms is type 0–IIa, in 326 (31.3 %) – type 0–Is, in 93 (9 %) – type IIa + IIc. According to the results of histological examination, the sessile type of structure was diagnosed in 158 (15.2 %) cases, non – sessile – in 883 (84.8 %). In 276 (26.5 %) cases, were detected adenomas with micro-foci of adenocarcinoma (tumor in situ). During the study period (2018–2021), one complication (0.09 %) of outpatient polypectomy by the “cold” method was observed. This complication was manifested by automatically stopped bleeding. Conclusion. Screening colonoscopy is one of the most effective diagnostic methods to detect CRC in asymptomatic patients. The “cold” polypectomy method has an important role in the prevention of CRC, as it is a safe procedure which can be performed on an outpatient basis.

Effects of Soft Tissue Massage Along with Mobilization Technique on Intensity of Symptoms and Functional Status of Carpal Tunnel Syndrome: A Randomized Controlled Trial

The median nerve in the wrist is compressed in the carpal tunnel, causing Carpal Tunnel Syndrome (CTS). The symptoms of this condition include numbness, tingling, and pain in the hand and fingers. The effectiveness of soft tissue massage along with mobilization techniques in managing CTS symptoms and improving functional status is an area to explored. Objective: To determine the effects of soft tissue massage along with mobilization technique on intensity of pain and functional status in Carpal tunnel syndrome patients. Methods: A randomized controlled trial was conducted on 60 patients with mild and moderate carpal tunnel syndrome at Sindh Institute of Physical Medicine and Rehabilitation, Karachi. In group A, soft tissue massage (Medenci hand massage technique) was combined with joint (radiocarpal and inter-carpal) and median nerve mobilization sliders, whereas in group B, only joint and median nerve mobilization sliders were used. A visual analog pain scale, the Boston scale of carpal tunnel syndrome, a dynamometer and a pinch gauge were used to evaluate participant on day 1 and the last treatment session. Results: There was no significant difference between group A and B after treatment. However, there was significant improvement (p&lt;0.05) in intragroup analysis in all outcome measures after treatment in both groups with p&lt; 0.05. Conclusions: Soft tissue massage along with joint and nerve mobilization is effective in symptoms severity and functional status. To further validate the findings of this study, similar investigations will need to be undertaken in the future to consider it before surgical intervention in CTS.

Application of navigation system in colonoscopy

Introduction. There are opinions that the use of modern high-tech additional techniques, including a navigation system for positioning a colonoscope (MEI), can both increase the diagnostic efficiency of colonoscopy and its comfort for the patient, and do not affect the quality of colonoscopy. Aim. To determine the capabilities of MEI during colonoscopy without sedation. Materials and methods. The single-center, prospective, randomized study included 120 patients (from 20 to 82 years, mean age 51.8 years; 53% men / 47% women) who underwent routine diagnostic outpatient colonoscopy using a rotational technique by experienced endoscopists using MEI navigation system. The study took place in two stages: Stage 1 – randomization and assessment of group comparability (group 1 – MEI, n = 57 and group 2 – without MEI, n = 63); Stage 2 – determination of the number of patients with colon preparation for colonoscopy according to the Boston scale &gt; 6 points (n = 112: 1st study-MEI group, n = 52 and 2nd control group, n = 60); comparative analysis between groups of the frequency of cecal intubation, time of cecal intubation, pain assessment on the VAS scale in cm. Statistical analysis was carried out using Fisher’s exact test, two-sided Mann-Whitney rank sum U test at a significance level of 0.05. Results and discussion. The groups were comparable in age, gender, preliminary indications for the study. The cecum was intubated significantly more often in group 1 (100% vs 90%, p &lt; 0.05). There was no significant difference in the time required for cecal intubation (p = 0.258) and the difference in the mean time required for cecal intubation was 22 seconds. The VAS pain assessment also did not reveal significant differences (p = 1.023). We determined that the increase in the frequency of cecal intubation using MEI by experienced endoscopists increases by 10% and reaches 100%, while the opinion about reducing the time of cecal intubation and improving patient comfort were not confirmed. Conclusion. MEI during rotational colonoscopy performed by experienced endoscopists increases the likelihood of cecal intubation during routine colonoscopy by 10%. MEI does not increase the time required for cecal intubation and is not associated with the frequency or intensity of pain or discomfort on the VAS scale in colonoscopy without sedation.

The role of diet in bowel cleansing for colonoscopy (results of prospective observation study). Prospective observations study

AIM: to evaluate the impact of dietary compliance in bowel cleansing for colonoscopy on the quality of the procedure.PATIENTS AND METHODS: one thousand patients who scheduled for diagnostic colonoscopy were included in the prospective observation study. The quality of bowel preparation was assessed using the Boston scale. Neoplasms were detected and endoscopically evaluated. The optical verification of tumors was used to calculate the indicators of identified adenomas and polyps (ADR and PDR).RESULTS: the quality of bowel cleansing by the Boston Scale was 6 (6; 8) points. One hundred eight (19.8%) patients did not follow the recommended diet. Poor preparation, which did not allow a total colonoscopy was found in 91 (9,1%) cases. The ADR was 37.4%, PDR — 43.4%. Logistic regression analysis showed that the noncompliance for diet recommendation was the only one significantly negative factor associated whit inadequate bowel cleansing.CONCLUSION: the leading factor worsening the quality of bowel cleansing was non-compliance with the prescribed diet before the colonoscopy.

Comparative Study of Extinguishing and Upcoming Manual Therapy Techniques in Dentists Having Stage II of Carpal Tunnel Syndrome

Background: Carpal Tunnel Syndrome occurs when median nerve is compressed as it travels through the wrist.The syndrome is characterized by pain in the hand, numbness, and tingling in the distribution of the median nerveand leads to reduction in grip strength and hand function. Stage II Carpal Tunnel Syndrome occurs when patientis involved in activities of repetitive movement of wrist during day. The study aimed to compare functionalimprovement in results after treating with Extinguishing manual therapy techniques and Upcoming manualtherapy techniques.Materials and Methods: In this experimental study 30 dentists having Stage II Carpal Tunnel Syndrome weretreated first with extinguishing manual therapy techniques (Phase I) for 10 days and then there was a gap of1 week to decondition the effects of Phase I. After deconditioning same group of patients were treated withUpcoming manual therapy techniques for 10 days. In both the Phases Conservative therapy was also included.Patient specific activity scoring scheme and Boston scale were used to compare the results.Conclusion: The study concluded that Upcoming manual therapy are more effective than extinguishing manualtherapy techniques in treating dentists having Stage II Carpal Tunnel Syndrome.

The Incidence and Risk Factors of Cisplatin and Carboplatin Ototoxicity in Pediatric Oncology Patients at Tertiary Oncology Center.

Pediatric cancers are relatively rare diseases when considering all types of cancer. Platinum-based chemotherapeutic agents are potent agents against a variety of pediatric malignancies. An important adverse effect of platinum-based agents is the occurrence of hearing loss. This hearing loss can pose a challenge to detect especially if the child is in his early of life. It will also significantly affect the child development of social, pedagogical, and personal dimensions. It is integral to identify incidence of platinum-based ototoxicity and risk factors that increase the likelihood of developing hearing loss in cancer children. We performed a retrospective chart review of 123 pediatric patients who had completed cisplatin and carboplatin therapy for a variety of malignancies. Patients were diagnosed at Princess Nourah Oncology Centre between January 2011 and December 2016, were less than 14years old at diagnosis. Audiograms were scored using the International Society of Pediatric Oncology (SIOP) Boston Scale (0-4), a validated grading system for cisplatin-related hearing loss. Ototoxicity was reported in 16 patients out of 123 with a rate of 13%. The incidence of ototoxicity was highest in CNS tumors such as medulloblastoma (37.5%) and optic glioma (25%). Males were at greater risk for developing hearing loss than females. Cumulative cisplatin dose and addition radiation therapy were also identified as risk factors for development of ototoxicity (P = 0.008). Nature and location of cancer, gender, cumulative dose, and addition of radiation therapy are important clinical biomarkers of cisplatin ototoxicity.

Measuring symptoms severity in carpal tunnel syndrome: score agreement and responsiveness of the Atroshi-Lyr\xe9n 6-item symptoms scale and the Boston symptom severity scale

PurposeTo assess score agreement between the Atroshi-Lyrén 6-item symptoms scale and the Boston 11-item symptom severity scale and compare their responsiveness in patients with carpal tunnel syndrome before and after carpal tunnel release surgery.MethodsThis prospective cohort study included 3 cohorts that completed the A-L and Boston scales (conventional score 1–5) on the same occasion: a preoperative and short-term postoperative cohort (212 patients), a mid-term postoperative cohort (101 patients), and a long-term postoperative cohort (124 patients). Agreement was assessed with Lin’s concordance correlation coefficient and Passing-Bablok regression analysis. Analyses using item response theory were conducted on responses from the preoperative/short-term postoperative cohort including testing of item infit/outfit. Reliability was assessed with Cronbach alpha. Overall and sex-specific effect sizes were calculated using Cohen’s d.ResultsLin’s CCCs were high (0.81–0.91). Passing-Bablok analysis showed constant and proportional differences in all cohorts except preoperative to short-term postoperative change. Both scales showed high reliability (alpha, 0.88–0.93). The IRT-based analyses showed infit/outfit values within the desired range. With IRT-based scoring, the A-L scale had significantly higher responsiveness than the Boston scale, overall (d, 2.02 vs 1.59), in women (d, 2.22 vs 1.77) and in men (d, 1.74 vs 1.36).ConclusionThe Atroshi-Lyrén 6-item symptoms scale and the Boston 11-item symptom severity scale show good agreement but are not equivalent in measuring CTS-related symptoms severity. When using IRT-based scoring, the Atroshi-Lyrén scale demonstrated significantly higher responsiveness.

IMPACT OF RETROFLEXED VIEW ON THE DETECTION OF LESIONS IN THE PROXIMAL COLON: ASSESSMENT OF 393 PATIENTS IN A PRIVATE TERTIARY HOSPITAL.

The gold standard test for colorectal cancer screening the colonoscopy. Although this is the test of choice, colonoscopy misses a significant number of lesions, mainly in the proximal colon. With the purpose of reducing the number of lesions missed, new techniques have been studied, amongst them, retroflexed view in the right side of the colon and the second direct forward view. Assessing the safety of the retroview in the proximal colon (cecum and ascending colon), its impact on the detection of lesions in the proximal colon and its advantage over the double right forward view using adenoma detection rate and adenoma miss rate. Three hundred and ninety-three patients who came to Hospital Mater Dei to undergo colonoscopy from March to July 2017, prospectively. Out of these, 372 were included in the study based on the following exclusion criteria: being under 18 years of age, inadequate bowel preparations (Boston scale <7), history of colectomy, inflammatory bowel disease or polypoid diseases. First, an endoscopist inserted the colonoscope into the cecum and examine the cecum and the ascending colon with a forward view twice. In the third insertion into the cecum, retroflexed view was performed, cecal mucosa was examined until the hepatic flexure in search of polyps missed on forward view. All lesions found were resected and sent for histological analysis. In 334 (89.8%) patients, retroflexed view was performed successfully, 65.8% of failures were attributed to the loops of the device which prevented the maneuver. The direct view identified 175 polyps in the proximal colon in 102 people. Retroflexed view detected 26 polyps missed by the direct view in 24 (6.5%) people, with a missing rate of 12.9% in the test with only the forward view. Out of the 26 polyps found in retroview, 21 (80.76%) were adenomas, one of them with a high-grade dysplasia. Eleven patients had polyps seen only in retroflexed view. Retroview has increased the polyp detection rate from 27.41% to 31.72% and the adenoma detection rate from 21.77% to 25%. The adenoma miss rate by the double direct view was 12.8%. Without the retroview, one polyp in every 13.91 colonoscopies would be missed (number needed to treat - NNT=13.91). There was no adverse event. The retroflexed view technique in the proximal colon was shown to be safe, fast and feasible in most cases. It increased the adenoma detection rate and was shown to be advantageous in this study wit benefit beyond the double direct view.

Evaluating lubiprostone for effective bowel preparation before colonoscopy

BackgroundColon preparation is a fundamental step for performing a successful colonoscopy. We aimed to evaluate the effectiveness of administering lubiprostone (LB) added to a single dose of oral polyethylene glycol (PEG) solution in achieving satisfactory colon cleanliness and decreasing the side effects.ResultsOne-hundred percent of the control group patients reported that the experienced taste was worse than expected, while in the intervention group half of the patients (50%) said that the taste was natural and 48% experienced taste worse than expected (p<0.0001). Regarding Boston bowel preparation scale (BBPS), there was a significant difference in the overall Boston scale (p=0.02) with more efficacy in the intervention group as 66% of patients in the intervention group had good bowel preparation (5–7) and 24% excellent preparation (8–9). On the other hand, the overall Boston scale in the control group showed that 54% of patients were between 5 and 7, and only 16% of patients had overall Boston scale 8–9. In terms of the side effects of the preparation in both arms, the majority of cases in the intervention arm did not complain of any side effects (78%), while the majority of the complaints were vomiting in 16% of the intervention cases.ConclusionThe current evidence suggested that adding LB to the colon preparation significantly improved the tolerability and efficacy.

The Impact of a Smartphone App on the Quality of Pediatric Colonoscopy Preparations: Randomized Controlled Trial.

BackgroundSmartphone apps have been successfully used to help adults prepare for colonoscopies. However, no study to date has investigated the effect of a smartphone app on pediatric colonoscopy preparation.ObjectiveThe aim of this study is to determine if an app (SB Colonoscopy Prep) designed to educate and guide patients through their colonoscopy preparation will yield benefits over paper-based instructions and information.MethodsIn total, 46 patients aged 5-18 years received either app-based or written material with instructions on how to take their prep medications as well as information about the colonoscopy procedure. Prep quality, the number of calls to the gastroenterology service, and patient arrival time were recorded. After the procedure, a questionnaire was given to each patient through which they graded their knowledge of the procedure both before and after receiving the app or written material.ResultsApp users had higher mean Boston scores versus control subjects receiving written instructions (7.2 vs 5.9, P=.02), indicating better colonoscopy preps. In total, 75% (15/20) of app users and 41% (9/22) of written instruction users had preps categorized as “excellent” on the Boston scale. We found no significant differences in knowledge about the procedure (app users: 10/20 [50%], written instruction users 8/22 [36%]; P=.37), phone calls to the gastroenterology clinic (n=6 vs n=2; P=.27), or arrival times at the endoscopy suite (44 min vs 46 min before the scheduled procedure time; P=.56).ConclusionsSmartphone app use was associated with an increased number of colonoscopy preps classified as “excellent” on the Boston scale. There was no significant difference between app users and the control group regarding the number of calls to the gastroenterology clinic, patient arrival time, or patient knowledge about the procedure.Trial RegistrationClinicalTrials.gov NCT04590105; https://clinicaltrials.gov/ct2/show/NCT04590105

1L- vs. 4L-Polyethylene glycol for bowel preparation before colonoscopy among inpatients: A propensity score-matching analysis

BackgroundInpatients are at risk for inadequate colon cleansing. Experts recommend 4L-polyethylene-glycol (PEG) solution. A higher colon cleansing adequacy rate for a hyperosmolar 1L-PEG plus ascorbate prep has been recently reported. AimsWe aimed to determine whether 1L-PEG outperforms 4L-PEG among inpatients. Methodspost-hoc analysis of a large Italian multicenter prospective observational study among inpatients (QIPS study). We performed a propensity score matching between 1L-PEG and 4L-PEG group. The primary outcome was the rate of adequate colon cleansing as assessed by unblinded endoscopists through Boston scale. Secondary outcome was the safety profile. ResultsAmong 1,004 patients undergoing colonoscopy, 724 (72%) were prescribed 4L-PEG and 280 (28%) 1L-PEG. The overall adequate colon cleansing rate was 69.2% (n = 695). We matched 274 pairs of patients with similar distribution of confounders. The rate of patients with adequate colon cleansing was higher in 1L-PEG than in 4L-PEG group (84.3% vs. 77.4%, p = 0.039). No different shift in serum concentration of electrolytes (namely Na+, K+, Ca2+), creatinine and hematocrit were observed for both preparations. ConclusionWe found a higher rate of adequate colon cleansing for colonoscopy with the 1L-PEG bowel prep vs. 4L-PEG, with apparent similar safety profile, among inpatients. A confirmatory randomized trial is needed. (ClinicalTrials.gov no: NCT04310332)

S0293 Co2 Insufflation vs Air Insufflation for Elective Colonoscopy at Two Reference Centers in Ecuador

INTRODUCTION: Insufflation of the intestinal tract, usually with room air, is necessary to improve visualization during colonoscopy. Pain and abdominal discomfort are usual complaints associated mainly with the use of air insufflation However, most patients complain of bowel distension and abdominal pain afterwards. Recently, carbon dioxide (CO2) rather than air insufflation has been used. The aim was to evaluate the efficacy, safety, and comfort of colonoscopy CO2 over air for insufflation. METHODS: Prospective analytical cohort study from July 2018 to February 2020, 876 colonoscopy examinations were randomized into two groups according to the gas insufflation used: Air Group (n = 460) and CO2 Group (n = 416). RESULTS: The Air and CO2 Groups were similar in respect to bowel preparation evaluated using the Boston scale, no statistically significant differences related to reasons for examination, presence or intensity of pain at the time of the procedure, age, gender, previous surgery, maneuvers necessary for the advancement of the device, and presence of polyps, tumors or signs of diverticulitis, sedation dosage, complications. The relative risk (RR) of immediate pain is 4.6 times higher when insufflation is done with air instead of CO2 (RR = 4.6; 95% CI: 3.2–8.1; P < 0.001). The risk of abdominal distension in the air group was 2.4 times higher than that of the group insufflated with CO2 (RR = 2.4; 95% CI: 1.6–3.9; P < 0.001). CONCLUSION: The use of CO2 is better than air as it avoids post-examination bloating, improves tolerance to colonoscopy, reducing pain and flatulence out to 6 hours following the procedure, without any additional adverse reactions, warranting routine clinical use.

EFFECTIVE BOWEL CLEANSING FOR SCREENING COLONOSCOPY

AIM: to assess the effectiveness and safety of sodium picosulfate for screening colonoscopy.PATIENTS AND METHODS: the retrospective study included 299 patients at mean age of 54±14 years who had screening colonoscopy, . All patients received sodium pikosulfate for bowel cleansing. The quality of bowel cleansing was evaluated by the Boston international scale. Organoleptic and subjective sensations were also evaluated.RESULTS: the quality of bowel cleansing was 8.5±1.0 point by Boston scale. As a result of screening colonoscopy in 96 (32.1%) patients, polyps of the rectum, sigmoid, colon and ileum were detected in 11%, 8%, 11% and 2% of cases respectively. Pathology showed that 78 (26%) patients had adenomatous polyps, 13 (4%) – adenocarcinoma. All patients reported comfortable use of the agent.CONCLUSION: sodium picosulfate fully meets the requirements for the drug used for bowel cleansing for colonoscopy.

Index of the Mayo Endoscopy and Ulcerative Colitis Endoscopy Index of Severity: are they equally valid?

endoscopy plays an essential role in the management of patients with ulcerative colitis (UC), as it allows us to visualize and assess the severity of the disease. Different scores have been devised to standardize the findings because such assessments are not always objective. the aim of this study was to assess the interobserver variability between the Index of Mayo Endoscopy (IME) and the Ulcerative Colitis Endoscopy Index of Severity (UCEIS), analyzing the severity of the endoscopic lesions in patients with UC. The secondary aim was to analyze if the cathartic preparation affected the degree of concordance amongst the endoscopists. this was a single-cohort observational, comparative study in which a colonoscopy was performed in patients with UC, as the normal clinical practice. The results were classified according to the IME and the UCEIS by three endoscopic specialists. In order to assess the degree of interobserver correlation, the Kappa index for IME was used and the intraclass correlation coefficient was used for UCEIS. sixty-seven patients were included in the study. The average age was 51 (SD ± 16.7) and the average Mayo Clinic index was 3.07 (SD ± 2.54). The weighted Kappa index between endoscopists A and B for the IME was 0.8, 0.52 between A and C and 0.49 between B and C. The intraclass correlation coefficient for UCEIS was 0.922 between the three endoscopists (95 % CI: 0.832-0.959). A better interobserver correlation was found when the cathartic preparation was ≥ 8 based on the Boston Scale. there was a higher correlation between the different endoscopists for the UCEIS than for the IME. Thus, this should be considered to be the best index to use in the clinical practice. A good cleansing preparation is important to improve the interobserver correlation.

Bowel Preparation for Colonoscopy in Children: 1 Day PEG-3350 with Bisacodyl versus 3 Day Sennosides

Background and Objectives: Bowel preparation (BP) for colonoscopy is a challenging procedure in children and different regimens have been used for this purpose. Polyethylene glycol (PEG) is the most preferred agent in recent years. The primary aim of this study was to evaluate the efficacy of 1-day PEG-3350 with bisacodyl (PEG-B) and comparing it with 3-day sennosides A+B. Method: In this prospective, randomized, and single-blinded study, children aged 2–18 years were included in the PEG-B group for 1 day or in Senna group for 3 days. The effectiveness of BP was assessed according to the Ottawa and Boston BP scales, compliance and adverse effects were also recorded. Pre- and post-preparation biochemistry were obtained for investigation of safety of both regimens. Results: Successful BP was observed in 88.3% (n = 53/60) of PEG-B and 86% (n = 55/64) of Senna groups according to Boston scale, and it was 85% (n = 51/60) and 84.4% (n = 54/64), respectively, according to Ottawa scale. The cecal intubation rate was 96.7% (n = 58/60) in the PEG-B group and 93.8% (n = 60/64) in the Senna group. Ease of administration and disturbance in regular daily activities was better in the PEG-B group (p < 0.05). There was no major adverse event and biochemical abnormality in both groups. The correlation between Ottawa and Boston scales was found to be excellent (r² = –0.954, p < 0.01). Conclusions: The efficacy, safety, and adverse effect profile of 1-day BP with PEG-B regimen was found to be similar to 3-day sennosides regimen, however, the PEG-B regimen had advantages such as short duration, ease of administration, and better patient comfort. Also, high correlation rate between the Boston and Ottawa scales in pediatric patients was remarkable.

Functional Bowel Disease.

Introduction: Combination of Rome III criteria have a moderate accuracy for diagnosis of Irritable bowel syndrome (IBS). Colonoscopies are performed to rule out other etiologies, and >50% are normal being considered as a “functional disease”. It has been described and impaired intestinal barrier function with mucosal inflammation in the small bowel of this patients, and recent reports evidence a possible organic disease. However, this fact has not been completely evaluated. Aim: to determine utility of Confocal Laser Endomicroscopy (p-CLE) identifying colorectal mucosa micro-inflammation in patients with IBS. Methods: Prospective, controlled, non-randomized and simple blind study (Jan-2016/Mar-2017), including patients with IBS according to Roma III criteria (IBS group), and healthy patients (control group). Exclusion criteria: patients receiving NSAIDs, corticosteroids or antibiotics, heart, kidney, liver or severe metabolic disease, IBD, bacterial overgrowth, gastrointestinal bleeding, history of colitis, colonic obstruction, colectomy, allergy to fluorescein, pregnancy and poor bowel preparation (Boston Scale<6). Both groups underwent colonoscopy using p-CLE with target-biopsy of each colorectal section. Altered crypt architecture, epithelial gaps with fluorescein leaks and dilated and prominent branching vessels were the considered p-CLE criterion for inflammation. Following Geboes Scale, biopsies where evaluated by an only pathologist blinded to endoscopic findings. Overall diagnostic accuracy was defined by sensitivity, specificity, PPV, NPV, observed and inter-rater agreement. Results: A total of 444 biopsies (74 patients) were included (mean age 53.1 [25-90] yo, 64.9% women). Normal colonoscopy was observed in all cases. There were an increased number of inflammatory lesions at p-CLE in IBS group (65.8%) compared with controls (23.4%) (OR 6.28; 4.14 - 9.52; P<0.01) (table 1). Goebes' grade >0 was more frequently in IBS group (60.8 vs. 27.5%; P<0.01). p-CLE for inflammatory findings in IBS, considering target biopsy as gold standard, reached a sensitivity, specificity, PPV, NPV, observed and inter-rater agreement of 86.7, 88.7, 85.9, 89.4, 87.8 and 75.4%. Conclusion: p-CLE proved to be a reliable method for detecting colorectal mucosa micro-inflammation in patients with IBS, showing that patients with IBS have 6 times more prevalence of mucosal colorectal microinflammatory than healthy patients.Inflammatory lesions at p-CLE, n (%)

Tolerancia, seguridad y eficacia de la preparación intestinal con un día de PEG3350 + bisacodilo en comparación con 2 días de PEG3350 + bisacodilo en pacientes pediátricos

BackgroundMultiple intestinal preparations have been used in children undergoing colonoscopy, with variable limitation due to acceptance, tolerance, and proper cleaning. The objective of this study was to compare the tolerability, safety and efficacy of the colonoscopy preparation with 1 day with PEG 3350 (poliethylenglycol) (4g/kg/day) + bisacodyl compared to 2 days of preparation with PEG 3350 (2g/kg/day) + bisacodyl in pediatric patients. MethodsA clinical, randomized, and blind trial was performed. Patients aged 2 to 18 years scheduled for colonoscopy were included. Patients were randomized into two groups: 1 day of preparation with PEG 3350 4g/kg/day + bisacodyl and 2 days of preparation with PEG 3350 2g/kg/day + bisacodyl. Through a questionnaire, physical examination and endoscopic evaluation (Boston scale), the tolerance, safety and efficacy of the 2 preparations to be evaluated were determined. Student's t test was performed for quantitative variables and χ2 for qualitative variables. ResultsThere were no significant differences in compliance rates, adverse effects, and extent of colonoscopic evaluation. ConclusionsTolerance and safety between the intestinal preparation for 1-day colonoscopy with PEG 3350 (4g/kg/day) + bisacodyl and the 2-day preparation with PEG 3350 (2g/kg/day) + bisacodyl were similar. The quality of cleanliness was good in both groups, being partially more effective in the 1-day group with PEG 3350 (4g/kg/day).

Tolerancia y efectividad de picosulfato de sodio/magnesio/citrato comparado con polietilenglicol para limpieza intestinal

IntroductionColonoscopy is the preferred procedure in disease of the large bowel, and is considered the reference standard in colorectal cancer detection. Adequate visualisation requires a simple, acceptable, effective, well tolerated bowel preparation, and with minimal adverse effects. The most common method for bowel cleansing is by using polyethylene glycol (PEG). The combination of sodium picosulphate and magnesium citrate (PMC) is gaining popularity as a new agent, but has not been studied extensively. The aim of this study is to compare the quality of bowel cleansing and as well as the tolerance between both preparations using a previous day regimen. Material and methodsA prospective and randomised trial was conducted with patients being assigned to receive PEG (4 l) or PMC (2 l) the day prior to colonoscopy. Each patient was interviewed to determine their tolerance. The quality of cleaning was evaluated using Boston scale by several endoscopists. ResultsA total of 124 patients were enrolled in the study and 105 were included in the analysis. The mean age was 54.2±14.4 years, and there were 48 (45.7%) male patients and 57 (54.3%) female patients. Nausea, vomiting, abdominal pain, bloating, thirst, dizziness, and headache were evaluated. Nausea was reported more often as a collateral effect in the PEG group (51%, P=.013). The mean score on the Boston scale for PEG group was 7.14±1.31, and for PMC group it was 6.94±1.62. There was no statistically significant difference between both groups (P=.32). Tolerance evaluated using a Likert scale was 4.05 for PEG and 4.47 for PMC, with this difference being significant (P=.014). ConclusionThis study shows that bowel cleansing with PMC is comparable with PEG in a previous day regimen, and PMC is also better tolerated than PEG.