Boston Scale Research Articles

Determinación de tasa de adenomas desapercibidos en pacientes con riesgo promedio de cáncer colorrectal con preparación intestinal inadecuada

IntroductionColonoscopy is the procedure of choice for the screening in average-risk colorectal cancer patients. Inadequate bowel preparation for a colonoscopy could result in not seeing lesions. These patients require a repeat procedure with a more complete colonic cleansing. The missed adenomas rate is one of the main risk factors in interval colonic cancer, and is one of the reasons why the procedure should be repeated. ObjectiveTo determine the missed adenomas rate in average-risk colorectal cancer patients with inadequate colonic cleansing by comparing two preparation groups in a second colonoscopy. MethodsA prospective, experimental, analytical, longitudinal and comparative design study was conducted on the second colonoscopy of two patient groups: An early preparation group (24hours), and late preparation group (after 24hours). Colonic cleansing, ileal and caecal intubation, polyps detected and resected in first and second colonoscopy were evaluated. ResultsA total of 52 patients were included, 21 (40.4%) with early preparation and 31 (59.6%) late preparation. Using the Boston scale, the mean preparation for the first colonoscopy was 4.37±0.81, and a mean of 8.24±0.83 in the second, and it was 6.81±0.91 in the late preparation (p=.0001). Polyp detection in the first colonoscopy was 5.76%, which increased to 30.7% in the second colonoscopy. ConclusionsMissed adenomas detection rate increased from 5.76% on first colonoscopy to 30.7% on the second. There was no difference between the preparation groups for polyp detection. An early preparation improves quality indicators in bowel cleansing, based on the Boston Scale, and ileal intubation.

Comparación de la efectividad de 2 esquemas de preparación intestinal para colonoscopia en el Hospital General de México

IntroductionColonoscopy is the “gold standard” for the detection of polyps and precancerous lesions. Adequate cleansing is essential for an effective colonoscopy. Intestinal preparations should be effective, safe and well tolerated by the patient. ObjetiveTo compare the bowel cleansing efficacy, tolerability and cost of 2 colonic preparations: 4l polyethylene glycol vs. 2l polyethylene+10mg bisacodyl. Material and MethodsA cross-sectional, prolective, comparative and analytical study was conducted including patients referred for colonoscopy due to any indication, aged between 18 and 85 years. We excluded patients with a history of allergy to the formulations used, heart failure and resection of a segment of the colon. Two groups were formed by simple randomisation: group 1 received the standard preparation of 4 litres of polyethylene glycol (PEG), and group 2 received 2l PEG and 10mg bisacodyl. ResultsThe study included a total of 92 patients, of which 18 were ruled out. Out of the final 74 patients, 37 (50%) were male and 50% were female. Group 1 included 39 patients (53%) and group 2 included 35 patients (47%), and the mean age was 50 years. Tolerance to the preparation was measured using a Likert scale, with a mean result of 4 points in both groups. Efficacy was measured using a Boston scale, with a value of 7.36 in group 1 and of 7.43 in group 2 (RR 0.063). ConclusionsThe study found no significant differences in colon cleansing and tolerance between groups. The preparation containing bisacodyl was less expensive.

Factores asociados al nivel de limpieza colónica medido mediante la escala de Boston en la práctica clínica habitual

IntroductionThe Boston scale is useful to standardize colon cleansing at colonoscopy. The aim of this study was to analyze the degree of preparation before colonoscopy and the factors associated with cleansing in routine clinical practice. Material and methodsWe included colonoscopies performed from January to June 2013. Exclusion criteria were age <15 years, a history of colon surgery, inflammatory bowel disease, and active gastrointestinal bleeding. The standard preparation was CitraFleet®. The parameters related to the degree of bowel cleansing (using the Boston scale) were age, sex, indication, colonoscopy shift (morning or afternoon), patient origin (outpatient or hospitalized), and colonoscopy findings. ResultsWe analyzed 947 colonoscopies, with exclusion of 297. A total of 5.8% (38/ 650) of the colonoscopies were incomplete, 50% due to lack of preparation. The mean age of the patients was 61.27 years (SD: 16.1), and 51.8% were women. The distribution of the Boston scale was 0-3 in 6.3%, 4-5 in 12.6%, 6-7 in 30.6%, and 8-9 in 50.4%, with a mean 7.04 (SD: 2.03). On multivariate analysis, the factors statistically associated with better preparation were younger age, afternoon colonoscopy and the outpatient setting. The percentage of polyps in patients with a Boston scale score ≤5 was 10% compared with 27.8% in patients with a score > 5 (P=.014). ConclusionIn clinical practice, 80% of patients had an acceptable level of preparation. Older patients, those undergoing colonoscopy in the morning and hospitalized patients would be candidates for measures to improve the degree of colonic preparation.

A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy

BackgroundLow-volume bowel preparations have been shown to provide an equivalent cleansing effect as that of a standard 4L polyethylene glycol. However, studies comparing the efficacy of low-volume bowel preparations are few, and the results have been controversial. This study aimed to compare the bowel cleansing quality and tolerability between sodium picosulfate/magnesium citrate and polyethylene glycol with ascorbic acid. MethodsA randomized study was performed with two hundred outpatients who were prospectively enrolled. The Boston Bowel Preparation Scale and the Aronchick scale were used to evaluate the bowel cleansing quality, and bubble scoring was also performed to back up both results. To investigate patients’ preferences and tolerability, a questionnaire was administered. ResultsSodium picosulfate/magnesium citrate was not inferior to polyethylene glycol with ascorbic acid in terms of successful bowel preparation (≥6 Boston scale score: 80% vs. 82%; p=0.718, adequate Aronchick grade: 93% vs. 96%; p=0.352). In addition, sodium picosulfate/magnesium citrate caused fewer gastrointestinal symptoms, and tasted better than polyethylene glycol with ascorbic acid. ConclusionsSodium picosulfate/magnesium citrate was not inferior to polyethylene glycol with ascorbic acid in cleansing efficacy, and was found to have higher tolerability.

Surgical treatment results of carpal tunnel syndrome in patients with and without type 2 diabetes mellitus.

Carpal tunnel syndrome (CTS) is the most commonly seen peripheral nerve compression syndrome and CTS surgery is the most common surgery done for peripheral nerve compression syndromes. Type 2 diabetes mellitus (DM) is a systemic disease with a component of peripheral neuropathy. We aimed to investigate the effects of type 2 DM on functional results in type 2 DM patients who underwent carpal tunnel surgery. The study included 39 patients with carpal tunnel syndrome which was confirmed by electromyography. Twenty-one patients did not have DM, 18 patients had type 2 DM that were treated for DM and had regulated blood glucose levels. Assessments were done with the Boston scale. All operations were done by the same surgical team using the same surgical technique. Functional and symptomatic scores between the two groups were compared with the Mann-Whitney U test which is the non-parametric version of the Student's t test, and 95% confidence interval p<0.05, which is considered as statistically significant. In patients with type 2 DM, preoperative mean Symptom Severity Score was 3.6±0.35 (2.9 to 4.2) in the last control mean Symptom Severity Score was 1.2±0.16 (1.0-1.7), and preoperative mean functional status score was 3.3±0.56 (2.3 to 4.5) and in the last control mean functional status score was 1.3±0.36 (1.0 to 2.4).The patients without DM, preoperative mean Symptom Severity Score was 3.5±0.45 (2.8 to 4.2) in the last control mean Symptom Severity Score was 1.2±0.19 (1.0 to 1.6), and preoperative functional status score was 3.2±0.47 (2.4 to 4.6) in the last control mean functional status score was 1.3±0.35 (1.0 to 2.5). There was no statistically significant difference between the two groups. Type 2 DM patients with regulated blood glucose levels can be operated without additional procedure during and after surgery for carpal tunnel syndrome like in carpal tunnel syndrome patients without DM.

Preparación con picosulfato sódico/citrato de magnesio en dosis fraccionadas para colonoscopias en turno de mañana realizadas entre las 2 y 6 horas posteriores a la ingesta de líquidos

BackgroundSplit dosage of bowel preparations has been shown to substantially improve bowel cleansing. AimTo compare the split dose (SD) sodium picosulphate/magnesium oxide/anhydrous citric acid (Citrafleet®) regimen for morning colonoscopies with standard cleansing the day before. MethodsConsecutive outpatients were randomized to receive Citrafleet® the day before colonoscopy or SD, in whom the second half was administered on an individual basis from 2 to 6hours before the procedure. No bisacodyl was administered. All procedures were performed with non-anesthesiologist administered propofol sedation. The Boston scale was used to assess the quality of bowel preparation (adequate cleansing if score ≥ 6, with no score of 0/1 in any segment). ResultsA total of 193 patients were included. Overall bowel cleansing was significantly better in the SD group (7 vs. 5.2, p<0.001), as well as in the cecum (2.4 vs. 1.4, p < 0.001), ascending colon (2.5 vs. 1.6, p<0.001) and transverse colon (2.4 vs. 2, p=0.004). A significant proportion of SD patients had adequate bowel cleansing (71% vs. 30%, p<0.001). Patients in the SD group drank a greater amount of liquid (4.9 vs. 4 liters, p=0.006) and more frequently perceived the cleansing process to be easy or very easy to complete (89 vs. 68%, p=0.04), although they slept significantly fewer hours (6.5 vs. 7.9, p<0.001). No bronchoaspiration pneumonia was reported. ConclusionsSD Citrafleet® 2 to 6hours before colonoscopy increased the rate of procedures with adequate bowel cleansing by 40%, especially in the proximal colon, allowed more liquids to be drunk and increased the perception of ease in completing the preparation, with no sedation-related complications.

La hora de ingesta del polietilenglicol es un factor clave en la tolerancia y eficacia de la preparación del colon en individuos de un programa poblacional de cribado de cáncer colorrectal

IntroductionThe quality and tolerability of antegrade gut lavage bowel preparation are key elements in the success of population-based colorectal cancer screening. ObjectivesTo evaluate cleansing quality and tolerability according to the timing of polyethylene glycol administration in persons undergoing colorectal cancer screening. MethodParticipants in colorectal cancer screening were randomized to two groups: a) control group (colonoscopy scheduled at 9-12h); preparation with polyethylene glycol on the previous afternoon; b) study group (colonoscopy scheduled at 12-15h): preparation with polyethylene glycol on the morning of the colonoscopy, with the option of a split dose. The quality of cleansing was evaluated with the Boston scale and tolerability through a questionnaire. ResultsA total of 282 participants were included: preparation was carried out the day before the procedure in 134 and on the same day in 148, of which 26 received a split dose. Cleansing was adequate in 95% (n=268) of the participants. The quality of cleansing was higher in the study group (P=.045). The interval between the end of administration and the beginning of the procedure was inversely correlated with the Boston scale score (P=.036; r=−0.125). Tolerability was unrelated to the time of administration (P>.2). Acceptance of the timing of administration was lower in the study group than in the control group (26% vs 10%, respectively; P=.001). ConclusionsPreparation as close as possible to the colonoscopy improves the quality of cleansing with no detrimental effects on tolerability, although this option is less comfortable.