Colonic Research Articles

2L polyethylene glycol combined with castor oil versus 4L polyethylene glycol for bowel preparation before colonoscopy among inpatients.

Inpatients are more likely to have inadequate bowel preparation compared to outpatients. Although experts recommend 4L split polyethylene glycol (PEG) preparation, bowel preparation with castor oil (CaO) was recently found to reduce the volume of solution required. The aim of the study was to evaluate the cleansing effect and safety of 2L-PEG with Cao in bowel preparation among inpatients. Our study retrospectively analyzed the medical records and colonoscopy reports of inpatients (n = 1251) who underwent colonoscopy in the Affiliated Changzhou No.2 People Hospital of Nanjing Medical University, and the inpatients were divided into 2L-PEG-CaO and 4L-PEG group according to different bowel preparation protocols. Boston Bowel Preparation Scale (BBPS) is used to assess bowel preparation efficacy before colonoscopy. Furthermore, we also calculated other outcomes, such as polyp or adenoma detection rates and adverse events. A total of 1251 patients undergoing colonoscopy were included in this study, 738 were taken 4L-PEG and 513 2L-PEG-CaO. Both inpatients groups were matched for baseline characteristics. The 2L-PEG-CaO group was significantly higher than the 4L-PEG group on both BBPS (7.26 ± 1.75 vs 7.06 ± 1.58, P = .043) and adequate bowel cleansing rates (83.2% vs 77.4%, P = .011). Regarding adverse events, the 4L-PEG group was significantly higher than the 2L-PEG-CaO group on the incidence of abdominal fullness (6.4% vs 9.6%, P = .045) and adverse events (33.7% vs 28.5%, P = .048). The 2L split PEG with CaO preparation increased quality of bowel cleansing and improved tolerance in inpatients. Bowel preparation with 2L-PEG-CaO is suitable alternative to traditional 4L split PEG bowel preparation for colonoscopy of inpatients.

Escrutinio para el cáncer de colon: ¿cuál fue el impacto en los primeros 2 años de la pandemia de COVID-19? Experiencia en una clínica privada ambulatoria.

COVID-19 pandemic had a negative impact on colorectal cancer (CRC) screening programs. The care strategy was modified throughout the pandemic, this paper evaluates its impact and short-term consequences. A retrospective, descriptive and cross-sectional study was carried out in a private ambulatory endoscopic center, in average risk subjects. The study compared two periods: pre-pandemic and pandemic (subdivided into pre-vaccination and vaccination). During this period, 54.4% of scheduled colonoscopies were due to the screening program. The average age was 60.4 ± 7 years. Women were 52.0%. The overall cancellation rate was 41.1%, higher during pre-vaccination period. There were no differences in the degree of colonic cleansing, colonoscope exit time, and patient satisfaction. The adenoma detection rate (38.4% vs. 42.8% vs. 36.4%; p = 0.8) and the total number of adenomas (p = 0.02) was statistically significant during the pre-vaccination period. The rate of adenoma/patient showed a higher trend during this period (p = 0.06). The number of colorectal cancers was 10, without differences between periods. In conclusion, the impact of the decrease in screening colonoscopy procedures for CRC detection was similar to what was seen worldwide. In this period no increase in cancer cases, although this effect may be observed in the long term.

Příprava střeva před koloskopickým vyšetřením – srovnání kvality očisty střeva a tolerance pacienty u několika očistných přípravků

Summary: High quality of bowel preparation before colonoscopy seems to be the most important condition for safety and efficacious investigation of the large bowel. An analysis of 758 patients who underwent colonoscopy in one health care center showed that split preparation is significantly associated with higher quality of the bowel cleansing. Application of drugs with simethicon component significantly reduce the risk of bubbles. Patients prefer small volume laxatives with good palatability. Key words: colonoscopy – bowel cleansing – bowel preparation

Intestinal Microbiota Reduction Followed by Fasting Discloses Microbial Triggering of Inflammation in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) synovitis is dominated by monocytes/macrophages with inflammatory patterns resembling microbial stimulation. In search of triggers, we reduced the intestinal microbiome in 20 RA patients (open label study DRKS00014097) by bowel cleansing and 7-day fasting (≤250 kcal/day) and performed immune monitoring and microbiome sequencing. Patients with metabolic syndrome (n = 10) served as a non-inflammatory control group. Scores of disease activity (DAS28/SDAI) declined within a few days and were improved in 19 of 20 RA patients after breaking the fast (median ∆DAS28 = -1.23; ∆SDAI = -43%) or even achieved remission (DAS28 < 2.6/n = 6; SDAI < 3.3/n = 3). Cytometric profiling with 46 different surface markers revealed the most pronounced phenomenon in RA to be an initially increased monocyte turnover, which improved within a few days after microbiota reduction and fasting. Serum levels of IL-6 and zonulin, an indicator of mucosal barrier disruption, decreased significantly. Endogenous cortisol levels increased during fasting but were insufficient to explain the marked improvement. Sequencing of the intestinal microbiota indicated that fasting reduced potentially arthritogenic bacteria and changed the microbial composition to species with broader metabolic capabilities. More eukaryotic, predominantly fungal colonizers were observed in RA, suggesting possible involvement. This study demonstrates a direct link between the intestinal microbiota and RA-specific inflammation that could be etiologically relevant and would support targeted nutritional interventions against gut dysbiosis as a causal therapeutic approach.

Effectiveness of Water-Assisted Colonoscopy without Sedation in Patients with Ulcerative Colitis

Background: Studies have found that water-assisted colonoscopy (WAC) including water immersion colonoscopy (WIC) and water exchange colonoscopy (WEC) is superior to air insufflation colonoscopy (AIC) in terms of the cecal intubation rate. However, the application of WAC in ulcerative colitis (UC) has rarely been reported. This study aimed to explore the effectiveness of WAC without sedation in patients with UC. Methods: One hundred and seventy-two UC patients were randomly divided into the AIC group (n = 56), WIC group (n = 58), and WEC group (n = 58). The cecal intubation rate, abdominal pain score, operator difficulty, bowel cleanliness, insertion, and total time were compared. Results: The cecal intubation rate was higher in the WIC (91.4% vs. 75.0%; mean difference = 16.4%; 95% CI: 3.0–29.8%) and WEC (93.1% vs. 75.0%; mean difference = 18.1%; 95% CI: 5.0–31.2%) compared to the AIC group, while there was no difference between the WIC and WEC groups. The abdominal pain score and operator difficulty were lower in the WIC and WEC groups than in the AIC group, while there was no difference between the WIC and WEC groups. The bowel cleanliness during withdrawal was higher in the WIC and WEC groups than in the AIC group, while the WEC was superior to WIC. Compared with the AIC and WIC groups, the insertion time and total time were longer in the WEC group, and there was no difference in the AIC group and WIC group. Conclusion: In comparison with AIC, WAC can increase the cecal intubation rate, reduce abdominal pain scores and improve bowel cleanliness in patients with UC.

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.

Revisiting bowel preparation: The quest for the optimal low‐residue diet duration

Revisiting bowel preparation: The quest for the optimal <scp>low‐residue</scp> diet duration

Effectiveness of using a patient education mobile application to improve the quality of bowel preparation: a randomised controlled trial

AimsTo determine the effectiveness of a mobile application (app) in improving the quality of bowel preparation for colonoscopy.MethodAn endoscopist-blinded randomised controlled trial enrolled patients who were undergoing a colonoscopy on...

Interobserver agreement between an artificial intelligence algorithm and colon capsule endoscopy readers on bowel-cleansing quality

Background and AimsColon capsule endoscopy (CCE) faces substantial challenges, one of which is achieving adequate colon cleansing. Furthermore, the interobserver agreement on bowel-cleansing quality varies. To address this issue, we developed an artificial intelligence algorithm (AIA) to evaluate bowel-cleansing quality. The aim of this study was to estimate the interobserver agreement on bowel cleansing between a group of experienced CCE readers and an AIA and to examine whether percentiles of the overall bowel-cleansing quality are a suitable way of reporting the results generated by the AIA.MethodsBowel-cleansing quality in 842 CCE investigations was scored on both a 2- and 4-point grading scale for the entire colon and by segment by experienced CCE readers and the AIA. For the algorithm, a score was given based on the mean score, median, upper and lower quartiles, and second and 98th percentiles. The level of agreement was evaluated using Cohen’s κ.ResultsThe interobserver agreement between the CCE readers and AIA on bowel-cleansing quality was minimal to none for the overall bowel evaluation, by segment, and on the 2- and 4- point grading scale regardless of the threshold for the AIA score.ConclusionsWe found minimal agreement on evaluation of bowel-cleansing quality in CCE between CCE readers and the AIA. Mean or percentiles of the AIA grading did not seem suitable for AI-generated bowel-cleansing evaluation. Colon capsule endoscopy (CCE) faces substantial challenges, one of which is achieving adequate colon cleansing. Furthermore, the interobserver agreement on bowel-cleansing quality varies. To address this issue, we developed an artificial intelligence algorithm (AIA) to evaluate bowel-cleansing quality. The aim of this study was to estimate the interobserver agreement on bowel cleansing between a group of experienced CCE readers and an AIA and to examine whether percentiles of the overall bowel-cleansing quality are a suitable way of reporting the results generated by the AIA. Bowel-cleansing quality in 842 CCE investigations was scored on both a 2- and 4-point grading scale for the entire colon and by segment by experienced CCE readers and the AIA. For the algorithm, a score was given based on the mean score, median, upper and lower quartiles, and second and 98th percentiles. The level of agreement was evaluated using Cohen’s κ. The interobserver agreement between the CCE readers and AIA on bowel-cleansing quality was minimal to none for the overall bowel evaluation, by segment, and on the 2- and 4- point grading scale regardless of the threshold for the AIA score. We found minimal agreement on evaluation of bowel-cleansing quality in CCE between CCE readers and the AIA. Mean or percentiles of the AIA grading did not seem suitable for AI-generated bowel-cleansing evaluation.

High-dose polyethylene glycol-3350 and gatorade solutions for patients with previous inadequate bowel preparations for colonoscopy are safe and effective

BackgroundInadequate bowel preparation for colonoscopy remains an issue resulting in lower adenoma detection rates and increased cost. We assessed the efficacy, safety and tolerability of high-dose bowel preparations in subjects who previously had an inadequate colonoscopy preparation.MethodsWe performed a multi-step prospective trial of high-dose bowel preparations with subjects assigned to the dose higher than their previous inadequate preparation. Step 1: 1.5 times the standard-dose of polyethylene glycol 3350 (PEG, 459 g) and Gatorade; and Step 2: 2.0 times the standard-dose of PEG (612 g) and Gatorade, both were given as extended split-dose preparations. 69 outpatients consumed their preparation before a morning colonoscopy. The primary endpoint was colon cleanliness assessed by the Chicago bowel preparation scale (BPS). Safety was assessed by comparing a baseline basic metabolic panel (BMP) to a post-cleansing BMP. Patients with no history of inadequate colon cleansing who consumed standard doses of PEG (306 g to 357 g) and Gatorade were used as a comparison group. Tolerability of the bowel preparation was assessed using a subject-questionnaire.ResultsWhen compared to controls consuming standard-dose bowel preparations, subjects consuming high-dose preparations had no statistically significant difference in colon cleanliness as measured by the modified or total Chicago BPS scores or differences in tolerability. Baseline and post-cleaning BMPs were not significantly different other than the BUN falling (p < 0.0001) after the preparation.ConclusionsThe multi-step high-dose bowel cleansing protocol proved highly efficacious, safe and well tolerated in subjects who previously had an inadequate colonoscopy preparation.Trial registration: ClinicalTrials.gov NCT02661750.

Efficacy of single-versus split-dose polyethylene glycol for colonic preparation

Background: Before a colonoscopy, polyethylene glycol (PEG) is often used to prepare the colon. PEG dosage recommendations are still up for discussion. In this randomized controlled experiment, the effectiveness and acceptability of PEG administered in single vs. split doses for colonic preparation was compared. Methods: A total of 120 individuals were randomized to either split-dose PEG for colonic preparation or a single-dose PEG at Department of Gastroenterology, Hayatabad medical complex. The Boston Bowel Preparation Scale (BBPS) was used for assessing the rate of bowel cleaning for the colonoscopy. A visual analog scale was used to evaluate the preparation's acceptability and tolerability. Results: The quality of colonic preparation was considerably greater in the split-dose PEG group than in the single-dose PEG group, as shown by the BBPS score, which was significantly higher in the split-dose PEG group (7.5±1.2) than in the single-dose PEG group (6.3±1.3) (P0.001). Patient satisfaction did not vary significantly between the two groups, but the split-dose PEG group had a higher completion rate of colonoscopies (97% vs. 95%) as well as greater patient acceptability and tolerance.

Could atmospheric temperature impact on adequate colon cleansing for colonoscopy? An observational, single-institution study

PurposeSeveral risk factors affecting the adequacy of colon cleansing have been proposed during the last decades. However, less is known about the impact that atmospheric aspects could have on adequacy of the bowel cleansing. The study aimed to investigate if the atmospheric temperature could impact on the bowel cleansing during colonoscopy.MethodsA prospective maintained database of the colonoscopies performed since 1st August 2017 to 31st March 2020 was retrospective reviewed. The primary outcome of the study was to identify if the atmospheric temperature was associated with inadequate colon cleansing during colonoscopy. Secondary outcome was to identify the other factors associated with an inadequate colon cleansing.ResultsOne thousand two hundred twenty patients were enrolled. High atmospheric temperature (> 25 °C) significantly influenced the colon cleansing (p < 0.0001). Adequate colon cleansing was negatively influenced by gender (female patients were associated with higher colon cleansing rate, p = 0.013), diabetes (p < 0.0001), previous pelvic surgery (p = 0.001), use of Beta-Blocker (p = 0.001), anti-platelet (p = 0.017), angiotensin converting enzyme inhibitors (p = 0.001), the adoption of 4 L Poly Ethylene Glycol solution (p = 0.009), single-dose regimen (p < 0.0001) low patients’ compliance (p < 0.0001), higher age and body mass index (p < 0.0001 and p = 0.025), lower education levels (p < 0.0001). On the contrary, admission to the ward to perform bowel preparation positively impacted on colon cleansing (p = 0.002).ConclusionAtmospheric temperature could play an important role in the colon cleansing during colonoscopy, being high temperature (> 25 °C) associated with lower rate of adequate bowel cleansing. However, being this relationship never studied before, these results must be confirmed by other studies.

Rare presentation and retrograde diagnosis of total colonic aganglionosis in a female infant: a case report

BackgroundTotal colonic aganglionosis is an extremely rare variant of Hirschsprung’s disease, which is predominant in males and can be seen in 1:50,000 live births. The presented case not only depicts a rare case, but also unusual clinical, laboratory, and instrumental data.Case presentationA 2-day-old Caucasian female newborn was transferred to our hospital from maternity. The initial presentation was reverse peristalsis, abdominal distention, and inability to pass stool. Fever had started before the patient was transferred. Hirschsprung’s disease was suspected, and tests such as contrast enema and rectal suction biopsy were done. Before enterostomy, the management of the disease included fluid resuscitation, colonic irrigation, antibiotic administration, enteral feeding, and supportive therapy. During ileostomy operation, no transition zone was visualized and full-thickness biopsy samples were retrieved from the rectum and descending colon. After surgical intervention, status significantly improved—defervescence and weight gain most importantly improved.ConclusionIt is well known that diagnosis of total colonic aganglionosis may be delayed for months or even years since the transition zone may not be visible and rectal suction biopsy, unlike full-thickness biopsy, is not always reliable. It might be more prudent not to be derailed because of negative radiography and rectal suction biopsy. Also, doctors should be more suspicious of the disease if signs and symptoms are starting to be consistent with Hirschsprung-associated enterocolitis, despite biopsy and radiology results.

Artificial Intelligence Applied to Colonoscopy: Is It Time to Take a Step Forward?

Growing evidence indicates that artificial intelligence (AI) applied to medicine is here to stay. In gastroenterology, AI computer vision applications have been stated as a research priority. The two main AI system categories are computer-aided polyp detection (CADe) and computer-assisted diagnosis (CADx). However, other fields of expansion are those related to colonoscopy quality, such as methods to objectively assess colon cleansing during the colonoscopy, as well as devices to automatically predict and improve bowel cleansing before the examination, predict deep submucosal invasion, obtain a reliable measurement of colorectal polyps and accurately locate colorectal lesions in the colon. Although growing evidence indicates that AI systems could improve some of these quality metrics, there are concerns regarding cost-effectiveness, and large and multicentric randomized studies with strong outcomes, such as post-colonoscopy colorectal cancer incidence and mortality, are lacking. The integration of all these tasks into one quality-improvement device could facilitate the incorporation of AI systems in clinical practice. In this manuscript, the current status of the role of AI in colonoscopy is reviewed, as well as its current applications, drawbacks and areas for improvement.

Impact of glucagon-like peptide 1 receptor agonist liraglutide and dipeptidyl peptidase-4 inhibitor sitagliptin on bowel cleaning and gastrointestinal symptoms in type 2 diabetes.

Objective: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 inhibitors (DPP-4i) profoundly affect the gastrointestinal motor system, which may increase the incidence of inadequate bowel cleaning and gastrointestinal symptoms. Hence, this observational study mainly aimed to assess the influence of GLP-1 RAs liraglutide and DPP-4i sitagliptin on bowel preparation in type 2 diabetes (T2DM). Method: This observational study consecutively enrolled T2DM scheduled for a colonoscopy. Participants were prospectively separated into the liraglutide group (n = 120), sitagliptin group (n = 120), and control group (n = 120) based on the current hypoglycemic regimen. 3L split-dose polyethylene glycol regimens were used for bowel preparation. Experienced gastrointestinal endoscopists conducted colonoscopies. Lawrance Bowel-Preparation Tolerability Questionnaire and Boston Bowel Preparation Scale (BBPS) were conducted to assess bowel cleaning quality, tolerability, and safety. Results: The incidence of inadequate bowel cleaning was 17.5% in the liraglutide group, 20.5% in the sitagliptin group, and 21.7% in the control group. The difference among the three groups was not statistically significant (p = 0.927). Meanwhile, there were no significant differences in the mean BBPS, cecal intubation time, and polyp-detecting rates among the three groups (all p > 0.0.05). Nausea, vomiting, and bloating scores were increased in the liraglutide group compared with the other two groups (p < 0.05), whereas most were mild or very mild. Subgroup analyses showed that the incidence of inadequate bowel cleaning in T2DM with diabetic peripheral neuropathy (DPN) was increased in the liraglutide group compared with the sitagliptin group (61.3% vs. 32.1%, p = 0.022) and control group (61.3% vs. 32.8%, p = 0.025). Conclusion: GLP-1RA liraglutide or DPP-4i sitagliptin did not significantly increase the incidence of inadequate bowel cleaning and gastrointestinal symptoms during bowel preparation. Liraglutide may increase the incidence of inadequate bowel preparation in patients with DPN. This study reveal that more attention and aggressive bowel preparation regimens should be given to the T2DM with DPN. Clinical Trial Registration: (https://www.chictr.org.cn/index.aspx), identifier (ChiCTR2200056148).

Small bowel cleansing for capsule endoscopy, systematic review and meta- analysis: Timing is the real issue.

The optimal small bowel preparation modality before capsule endoscopy (SBCE) is still uncertain, regarding preparation type, dose and timing of administration. The aim of the study is to evaluate the small bowel cleansing in patients undergoing small bowel capsule endoscopy after fasting alone or active treatment with purgative solutions. We searched 4 major scientific databases from inception to December 2021 for studies evaluating small bowel preparation before SBCE. Different preparation efficacy was compared using fasting as reference. Main variables evaluated in the current study were: preparation type, administration schedule and timing. 17 studies (27 treatment arms) with 2372 patients (male 47,4%) were included, mean age 54 years. Fasting alone VS overall purgative preparations pooled rate difference (RD) was 0.15 I2=81.5% p: 0.000. Sub-analysis for preparation schedule (day-before, split and same-day) and the time lapse showed that administration of PEG after the ingestion of capsule had the highest rate of adequate small bowel cleansing with a RD 0.33, administration between 1 and 6h before SBCE had a RD 0.28, 6 to 12h had a RD 0.21 and ≥12h had a RD 0.05. Timing of ingestion was found to be critical for bowel cleansing; the shorter time laps between the ingestion last dose of laxative and SBCE, the better was the mucosal visualization.

Effectiveness of Lactulose for Colonoscopy Preparation in Adults:A Meta-Analysis

Objective: To evaluate the effects of lactulose for bowel preparation prior to colonoscopy in adults. Methods: By searching for literature pertaining to RCT (randomized controlled trial) of bowel preparation with lactulose in adults up to 10th of July, 2021. The experimental group utilizes lactulose oral solution as the solution of choice for bowel preparation while the control group uses the standard bowel preparation solution. Literature selection and data extraction were completed independently by 2 researchers, including literature quality control. Data analysis was completed using the software RevMan5.2. Results: 11 RCT was included for data analysis. Meta-analysis showed that the lactulose group had a lower incidence of adverse effects [OR=13.58, 95CI% (6.10, 30.24), p&lt;0.0001] and better tolerability [OR=13.58, 95CI% (6.10,30.24), p&lt;0.0001] when compared with the control group. However, the bowel cleanliness was statistically insignificant between the two groups [WMD=0.26，95%CI (-0.31，0.82), p=0.38]. Conclusion: according to current evidences, as a solution for bower preparation, lactulose has a lower incidence of adverse effects such as emesis or diarrhea, while effectively increasing tolerability, however it is not a superior solution for bowel preparation in terms of bowel cleanliness when compared with other standard choices. More high quality researches will be required to support its use.

A study to assess the Nurses knowledge &amp; compliance to the protocol of adequate bowel preparation for colonoscopy

Introduction: Cleansing the colon before a colonoscopy is called bowel preparation, or “prep.” It involves taking medication that causes frequent, loose bowel movements to empty the colon. The medication is taken by mouth and typically comes in liquid form. Bowel cleansing is one of the most important parameters included in the evaluation of colonoscopy quality. The available evidence suggests that inadequate bowel preparation reduces the diagnostic yield of colorectal neoplasia and increases post-colonoscopy colorectal cancer risk. Nowadays, up to 30% of patients referred for colonoscopy have poor bowel cleansing. Recently, several studies have analyzed the risk factors for inadequate bowel cleansing as well as the strategies to optimize bowel preparation. Poor bowel preparation has been shown to be associated with low lower-quality dilators of colonoscopy performance. Patients with Personal History of Inadequate Bowel Preparation, Diabetes Mellitus, Chronic Constipation, and a History of Colorectal Resection are at risk of inadequate bowel preparation for colonoscopy. Methodology: In November 2022, there was an increase in consultant complaints about inadequate Bowel preparation for the patient in the ward &amp; ICU which impacted on proper diagnosis of the actual reason the patient took admitted at Apollo Hospitals, Bhubaneswar. So on basis of the complaints, a quasi-experimental group pre-test was conducted &amp; found the less compliance. To look forward to checking the compliances, training &amp; educational materials were prepared on basis of protocol of adequate bowel preparation for colonoscopy (education materials contained agents, methods (single/split) of preparation, dietary patterns, stool consistency assessment) &amp; started implement from December 2022 onwards in both one to one &amp; group teaching. And by end of February 2023, a post-test was conducted to assess the improvement of knowledge of Nurses. To collect the data of their practices on adequate bowel preparation a structured PIP (performance Improvement Project) tool was used &amp; total sample took 100 assigned Register Nurses who all were assigned the In-patients for Colonoscopy. Results: With constant reinforcement, educational materials on adequate Bowel preparation of Colonoscopy &amp; knowledge assessment of assigned nurses made an impact on the effective intervention in adequate Bowel preparation. The impact of compliance to assess the knowledge &amp; interventions of nurses in adherence to the protocol of Adequate Bowel preparation for colonoscopy. The knowledge of Nurses found less compliance in the Pre-Test which was conducted after consultant’s complaints in the month of November 2022 with 55.83% &amp; then after training &amp; educational materials were prepared on basis of protocol of adequate bowel preparation for colonoscopy {education materials contained agents, methods (single/split) of preparation, dietary patterns, stool consistency assessment)} &amp; started implement from December 2022 onwards in both one to one &amp; group teaching. And by end of February 2023, a post-test was conducted to assess the improvement of knowledge of Nurses &amp; found compliance percentage of 78.33%. And Compliance with adherence to the proper method of Bowel Preparation Protocol found compliances month on month, in December 2022 it was 30.29%, in January 2023 it improves to 55.26% &amp; reaches with compliances of 78.94% by the end of February 2023. Conclusion: In patients under the care of nurses who underwent enhanced education on bowel preparation had significantly better bowel preparation quality and higher compliance rates than those in inpatients of the control group. Nurses’ education was identified as an independent risk factor for bowel preparation quality. To make bowel preparation adequate &amp; sufficient frequent updating on knowledge of the recruited nurses need to be done on regular basis.

Проблемні питання стану здоров’я дітей зі spina bifida в Україні

Spina bifida is one of the most common congenital neural tube defects, which leads to dysfunction of many organs and systems and to disability. Purpose - to conduct a comprehensive analysis of the health status of children with spina bifida and hydrocephalus in Ukraine based on questionnaires of parents and their children, study of medical documentation and online counseling to improve the multidisciplinary support to children of this group. Materials and methods. A program of multidisciplinary online support for children with spina bifida in Ukraine was launched in June 2022 at the initiative of the patient organization «Association of parents of children with spina bifida and hydrocephalus «Lights of Spirit» and with the support of the international organization «Child Help». At the first stage, parents of children with spina bifida filled out a questionnaire to participate in the project, where demographic data and data on the child’s health were indicated. A total of 149 children with spina participated in the project. Girls predominated among the children (63.1%). The age of the patients ranged from 1 month to 24 years. At the next stages, online counseling was conducted with the participation of doctors of the multidisciplinary team and the head of the «Light of Spirit» NGO. Results. Impaired motor function was observed in 87.2% of children with spina bifida. Only 32.9% of children could walk independently, 14.1% needed outside help or aids, and 42.3% used a wheelchair or wheelchair to get around. Orthopaedic pathology was observed in 75.2% of patients, and hydrocephalus in 65.8% of children. A neurogenic bladder was noted in 79.9% of patients at the time of the questionnaire, and urinary tract infections (UTIs) in 77.9%. Clean intermittent catheterization was regularly performed in only 51.7% of patients. The study showed that early initiation of catheterisation was associated with a lower incidence of UTIs. Constipation was observed in 81.9% of children, faecal micturition and/or faecal incontinence in 58.4% of children. Bowel cleansing was performed in 49.7% of patients, and only 26.8% regularly. Skin damage (wounds and bedsores) was observed in 12.8% of children, and allergic manifestations in 21.8% of patients. Only 15% of children were immunized in accordance with the national vaccination schedule, and 70% of children were not vaccinated at all. Body weight disorders were observed in 43% of children, most often overweight/obesity (32.2%). Conclusions. A comprehensive analysis of the health status of children with spina bifida and hydrocephalus in Ukraine made it possible to outline a number of problems of children with this pathology, which affect quality of life and require a multidisciplinary approach to treatment and rehabilitation. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

COMPARISON OF PREOPERATIVE BOWEL PREPARATION MODELS OF PATIENTS WHO UNDERWENT SURGERY FOR COLORECTAL CANCER

Background&#x0D; The most prevalent cancer in society is colorectal cancer (CRC). Studies aiming to lower surgical morbidity and mortality have found a significant contribution from preoperative bowel preparation. Models for bowel preparation included mechanical cleaning, the use of antibiotics, and control groups. We compared preoperative bowel preparation for elective colorectal cancer and evaluated its effects in this study.&#x0D; Material and Methods&#x0D; Preoperative bowel preparation model was used to prospectively split 144 patients (n=144) with colorectal cancer into four groups. Patients in the first group (Group I) underwent mechanical bowel preparation (MBP), followed by oral antibiotic therapy (OAB) and MBP in the second group (Group II), intravenous antibiotic therapy (IVAB), MBP, and OAB in the third group (Group III), and no bowel preparation in the fourth group (Group IV). Demographic information, anastomotic leakage, surgical site infection, intraabdominal abscess, postoperative ileus, and death were compared between patients.&#x0D; Results&#x0D; Groups I, II, III, and IV of the study each had 35 patients, 38 patients, 35 patients, and 36 patients, respectively. There was no statistically significant difference between the four groups when the groups were evaluated by age, gender, and ASA (American Society of Anesthesiologists) score (p&gt; 0.05). There were significant differences between surgical site infection (SSI), intraabdominal abscess, and anastomosis leaking (p0.05). Mortality and postoperative ileus did not differ significantly (p &gt; 0.05).&#x0D; Conclusion&#x0D; We consider that the bowel preparation approach of mechanical colon cleansing and antibiotic administration is appropriate for patients who have had surgery owing to elective CRC.