Oral Polyethylene Glycol Research Articles

Oral Sulfate Solution versus Polyethylene Glycol as a Single-Day Preparation for Colonoscopy: A Randomized Control Trial

Abstract Background Colonoscopy is a principal diagnostic tool for most colonic disorders. Adequate bowel preparation is essential for proper visualization of the mucosa. The aim of this study was to compare the tolerability, efficacy, and safety profile of 1 L of oral sulfate solution (OSS) in comparison to 2 L of polyethylene glycol (PEG) solution. Methods In this single-center prospective study conducted at our institute, patients were randomly assigned to receive either OSS or PEG solutions for colonoscopy preparation. Patients enrolled in either group completed a questionnaire assessing the taste of the solution used, adverse effects, and number of stools passed. Grading of the bowel cleansing quality was done as per Boston Bowel Preparation (BBP) score. Results Total of 400 patients, with 222 patients in the PEG group and 178 patients in the OSS group, were assessed. In the PEG group, 148 (66.75%) patients were males and in the OSS group 112 (62.9%) patients were males. There was no statistical significance on comparison of the taste as “good” or “bad” in both groups. All the adverse events were mild to moderate in intensity and their frequencies were comparable for both the groups. The OSS group had better bowel preparation as per the BBP score (p = 0.021) and lesser cecal intubation time (p = 0.028). Conclusion The present study demonstrated that 1 L of OSS is better than the well-established 2 L PEG solution, in terms of bowel preparation and shorter time to cecal intubation.

One-day oral polyethylene glycol based cleanout is effective for pre-colonoscopy preparation in children

BackgroundThe adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients. There is a lack of consensus, among providers on a standard pre-procedure regimen. Professional society guidelines include the use of Polyethylene glycol (PEG). Herein we report on the provider-assessed adequacy of a one day, age-categorized dosing, PEG based cleanout regimen in children undergoing colonoscopy in a tertiary institution.MethodsThe standard bowel preparation regime at our institution includes an age dependent minimum PEG dosing regimen in addition to clear liquids the day prior to the procedure. We retrospectively abstracted relevant indices including patient demographics, prep quality, procedure impairment, duration and completion from an institutional quality monitoring survey tool between 2015 and 2016 and similarly abstracted prospectively recorded indices that included the dataset above as well as additional fields for procedure deviations and additional laxative use.ResultsA total of 642 procedures (mean age 12.2 years; F: 380) were accrued, nonadherence to the cleanout regimen (7.3%) and additional laxative use (3.1%) were observed in a small proportion of the prospective dataset subjects, adequate cleanout defined as thin or thick liquid but no solids present was reported in 79.5% and 15.8% of cases and impaired study from inadequate cleanout was reported in 11.8% of studies albeit the cecum was reached and the terminal ileum was intubated in 97.8 and 93.6% of studies. The duration of the study was significantly longer with the presence of a fellow trainee assisting in the procedure. Patient age and gender did not correlate with prep adequacy or cecal and ileal intubation rates, inadequate cleanout was significantly associated with impairment and incomplete studies.ConclusionA one day, single agent, osmotic laxative (Polyethylene glycol) based cleanout regimen is effective in routine pre-procedure cleanout for standard colonoscopy in pediatric age range patients.

Acute Myocardial Infarction Following Administration of Polyethylene Glycol Electrolyte Solution with Ascorbic Acid (MoviPrep®) at Home: A Case Report.

A male individual aged 82 years with hypertension who had a smoking history, but no history of cardiovascular events, developed acute myocardial infarction immediately after he took oral polyethylene glycol electrolyte solution with ascorbic acid as a pretreatment for a colonoscopy to examine anemia. He took polyethylene glycol electrolyte solution with ascorbic acid at twice (2 L/h) the rate recommended in the package insert and by the physician. The patient showed impaired consciousness 2 h after taking polyethylene glycol electrolyte solution with ascorbic acid and his family called the emergency medical service. Upon arrival of the emergency medical service, his systolic blood pressure was 60 mmHg and heart rate was 50 bpm. Systolic blood pressure and impaired consciousness were slightly improved, but compensatory shock remained, at arrival at the emergency outpatient service at our hospital. No dyspnea or rash was apparent. The patient had no subjective chest pain; however, ST-segment elevation was detected in the electrocardiogram at II, III, aVF, V3R, and V4R. He was diagnosed with ST-segment elevation myocardial infarction and underwent a coronary catheter intervention for total occlusion of the right coronary artery. His shock state was abolished by this intervention. The patient was pretreated with polyethylene glycol electrolyte solution with ascorbic acid under close watch in the coronary care unit 4 days later, with no relapse of symptoms. Advanced cancer was found in the ileocecum by colonoscopy; consequently, the patient underwent a colectomy and was discharged from our hospital and transferred to another hospital for rehabilitation on hospital day 74. A Naranjo assessment score of 4 was obtained, indicating a possible relationship of acute myocardial infarction with misuse of the suspect drug, polyethylene glycol electrolyte solution with ascorbic acid.

Clinical research of different bowel cleansing methods on bowel preparation operation before enteroscopy

Objective To study the clinical effect and preoperative nursing of different bowel methods in intestinal preparation before colonoscopy. Methods A total of 200 patients who underwent colonoscopy in our hospital from April 2013 to April 2014 were randomly selected and divided into experimental group and control group.The two groups were given oral polyethylene glycol electrolyte solution (PEG-ELS) and castor oil.The defecation character and number of patients after taking the medicine, the cleanliness of the intestinal tract, the reaction of the patients after taking the medicine, and the occurrence of bubbles in the intestinal cavity were observed.Blood pressure and heart rate should be measured before and after colonoscopy, and the electrolyte is determined by routine blood test.The sleep quality of the two groups was assessed by Pittsburgh sleep quality assessment. Results The bowel preparation time was about 2 to 5 hours by using polyethylene glycol electrolyte solution cleansing method.However, the bowel preparation time of patients who took electrolyte solution with the addition of castor oil cleansing method orally was about 6 to10 hours, and the difference had statistical significance(P 0.05). The effect of the two groups on sleep quality was statistically significant(P<0.05). After the patients of both groups took medicine, the influence difference on sleep quality had statistical significance(P<0.05). Conclusions Relative to the bowel cleansing effect of taking castor oil orally, the nursing of taking polyethylene glycol electrolyte solution orally to cleanse bowel is simple, which can replace the traditional methods of taking electrolyte solution and castor oil orally. Key words: Polyethylene glycol-electrolyte solution; Bowel preparation; Colonoscopy examination; Clinical effect; Nursing

Effect of biofeedback therapy for functional constipation in elderly patients

Objective To evaluate the clinical value and effect of biofeedback training therapy for functional constipation in elderly patients. Methods A total of 78 elderly patients with functional constipation were treated at the People's Hospital of Pudong New Area, and were divided randomly into two groups.The control group (n=39) received routine treatment plus oral polyethylene glycol, while the experimental group (n=39) received biofeedback training treatment in addition to what was offered to the control group.After treatment, constipation symptom scores, anorectal dynamic parameters and clinical effects were compared between the two groups. Results The scores on excrement characteristics, defecation difficulty, and time and frequency of defecation were better in the experimental group than those in the control group (t=5.670, 4.740, 4.170, 5.530; P=0.016, 0.034, 0.039, 0.022, respectively). The overall effectiveness rate was 94.9% (37/39) in the experimental group, which was higher than that (71.8% , 28/39) in the control group (χ2=4.493, P=0.030). Meanwhile, the levels of 3SC and 10SC in the two groups were higher than those before treatment, but the level of 10SR was lower than that before treatment (all P<0.05). Moreover, improvement in 3SC, 10SC and 10SR were more significant in the experiment group than in the control group (all P<0.05). Conclusions Biofeedback training therapy is safe and effective for elderly patients with constipation to relieve constipation symptoms, enhance control of defecation and promote defecation. Key words: Constipation; Biofeedback

Efficacy and Safety of Combined Oral and Enema Therapy Using Polyethylene Glycol 3350-Electrolyte for Disimpaction in Pediatric Constipation

PurposeWe evaluated the efficacy and safety of combined oral and enema therapy using polyethylene glycol (PEG) 3350 with electrolyte solution for disimpaction in hospitalized children.MethodsWe retrospectively studied 28 children having functional constipation who received inpatient treatment between 2008 and 2016. The amount of oral PEG 3350 electrolyte solution administered was 50–70 mL/kg/d (PEG 3350, 3–4.1 g/kg/d), and an enema solution was administered 1–2 times a day as a single dose of 15–25 mL/kg (PEG 3350, 0.975–1.625 g/kg/d). A colon transit time (CTT) test based on the Metcalf protocol was performed in some patients.ResultsAdministration of oral and enema doses of PEG 3350 electrolyte solution showed 2.1±0.3 times and 2.9±0.4 times, respectively. After disimpaction, the frequency of defecation increased from 2.2±0.3 per week to once a day (1.1±0.1 per day). The number of patients who complained of abdominal pain was reduced from 15 (53.6%) to 4 (14.3%). Before hospitalization, nine patients underwent a CTT test, and 5 of 9 patients (55.6%) were classified as belonging to a group showing abnormalities. And in some patients, mild adverse effects were noted. We examined electrolytes and osmolality before and after disimpaction in 16 of 28 patients, and no abnormalities were noted.ConclusionIn terms of therapeutic efficacy and safety, combined oral and enema therapy using high-dose PEG 3350 with electrolytes is considered superior to conventional oral monotherapy or combined oral and enema therapy on an outpatient basis.

Comparison of Bowel Preparation Quality Scales Used in Randomized Controlled Trials of Patients Undergoing Colonoscopy

Introduction: Adequate bowel preparation (BP) is critical for a successful colonoscopy. Inadequate BP can negatively impact adenoma detection rates, withdrawal time, and necessitate early repeat colonoscopy. Discrepancies in BP quality reporting exist across clinical trials due to the lack of a uniform quality scale. While validated BP quality scales such as the Aronchick scale, Ottawa scale, and Boston BP scale exist, some registration trials have used custom-made non-validated scales. The goal of this analysis is to compare BP quality scales from recent pivotal trials of BP agents. Methods: Three BP quality scales were identified from 8 clinical trials of 4 BP agents: sodium picosulfate and magnesium citrate (P/MC), oral sulfate solution (OSS), OSS and 2L polyethylene glycol solution (OSS+PEG), and 2L PEG plus ascorbic acid (PEG+AA). Responder or success criteria were obtained from each study and specific details regarding visibility of mucosa, remaining stool, and need for suctioning were compared. The minimal responder criterion for OSS and OSS+PEG trials allowed “small amounts of feces or fluid not interfering with the exam,” while in PEG+AA trials an A or B rating was classified as responder, requiring stool be fully displaceable allowing for complete visualization. P/MC trials required an “Excellent”/“Good” Aronchick scale rating for responders. A “Fair” Aronchick rating was classified as a nonresponder and defined as “>90% mucosal visibility, liquid or semisolid stool, and could be suctioned or washed.” To highlight the variability between the different scales, we performed a post hoc analysis reclassifying Aronchick responders as “Excellent”/“Good”/“Fair.” Results: Based on the nonresponder criteria of the OSS, OSS+PEG, and PEG+AA clinical trials, we reclassified responder in P/MC trials to include the “Fair” Aronchick rating. In the original studies, 84.2% and 83.0% of P/MC patients were classified as a responder using the “Excellent'/”Good” criterion, whereas responder rates for P/MC patients were 99.7% and 98.7% after realignment. Conclusion: Differences in BP quality scales create confusion when comparing responder rates between trials. The percent of Aronchick scale responders in the P/MC trials varied from 84.2% to 99.7% depending on how responder was defined. The use of validated BP quality scales with stringent scoring criteria, such as that defined as “Excellent/Good” in the Aronchick scale, would help clarify clinical trial data related to quality measurements and improve outcomes.

Application of Oral Lactulose in Combination With Polyethylene Glycol Electrolyte Powder for Colonoscopy Bowel Preparation in Patients With Constipation

The aim of the study was to investigate the efficacy of combined application of lactulose oral solution and polyethylene glycol electrolyte powder compared with conventional method in preparing for colonoscopy bowel cleanliness in patients with constipation. Ninety patients, who had constipation and needed to have colonoscopy, were divided into study group and control group with 45 cases in each group, respectively. One day before the colonoscopy, patients in the experimental group were given lactulose oral solution and polyethylene glycol electrolyte powder, whereas the patients in the control group were given oral polyethylene glycol electrolyte powder only. The following parameters were then obtained: time of the first defecation (duration of the time from taking the drugs to the first bowel movement), defecation frequency, completion of bowel cleaning (duration from the first bowel movement to the stool becoming clear), and adverse reaction. Cleansing effect in the study group bowel preparation was significantly better than that in the control group (P < 0.05). Specifically, time of the first defecation and completion of bowel cleaning were statistically shorter in the study group than those in the control group (P < 0.05), and defecation frequency was significantly higher in the study group than that in the control group (P < 0.05). Incidence of adverse reaction, however, was not significantly different between the 2 groups (P > 0.05). Combined application of lactulose oral solution and polyethylene glycol electrolyte powder is superior to the conventional method of polyethylene glycol electrolyte powder alone for colonoscopy bowel preparation in patients with constipation. Therefore, combined clinical application of the 2 compounds is strongly recommended for colonoscopy bowel preparation in patients with constipation.

Cost-analysis model of colonoscopy preparation using split-dose reduced-volume oral sulfate solution (OSS) and polyethylene glycol with electrolytes solution (PEG-ELS)

Objective:The study aimed to (1) develop a cost model for colonoscopy preparation among patients referred for colonoscopy using split-dose reduced-volume oral sulfate solution (OSS) and generic polyethylene glycol with electrolytes solution (PEG-ELS), (2) examine cost savings associated with OSS vs PEG-ELS, and (3) assess the robustness of the cost model.Methods:Efficacy of each agent was based on the results of a 541-patient clinical trial comparing OSS to PEG-ELS. Cleansing agent and colonoscopy procedure costs were calculated from OptumHealth Reporting & Insights claims data for 2010–Q12013. In the model, patients’ colonoscopies were tracked over a 25 or 35 year time period until the patients reached age 75. The difference per patient per year (PPPY) in total cleansing agent and colonoscopy procedure costs over the time horizon between the OSS and PEG-ELS cohort was calculated. One-way sensitivity analyses were conducted to test the robustness of the cost model.Results:The model showed lower cost for OSS patients over the time horizon. Total PPPY costs were $280.34 for the OSS cohort and $296.36 for the PEG-ELS cohort, resulting in a cost saving of $16.01 PPPY for the OSS cohort. This was due primarily to OSS patients having fewer colonoscopies (OSS: 0.158 vs PEG-ELS: 0.170 PPPY). Over the time horizon, cost savings of $4 763 335 were observed among 10, 000 OSS patients. Cost savings switched from OSS to PEG-ELS cohort in four cases: (1) base-case cost of a completed colonoscopy decreased by 75%, (2) base-case cost of OSS increased to over $143 per usage, (3) all non-completers were lost to follow-up, and (4) OSS bowel preparation quality dropped below PEG-ELS to 70%.Conclusions:From a payer’s perspective, the model showed that the use of OSS as the cleansing agent resulted in potential cost savings compared with PEG-ELS. Cost savings under OSS remained under various sensitivity analyses.

New Low-Volume Bowel Cleansing Solution (NER1006) Versus Trisulfate, Polyethylene Glycol 3350+Ascorbate or Sodium Picosulfate/Magnesium Salt: 3 Multicenter Randomized Parallel Group Ph3 Studies in 1,865 Colonoscopy Patients

Introduction: A Phase 3 program aims to establish efficacy, safety, tolerability of NER1006, a new oral low-volume polyethylene glycol (PEG) solution with ascorbate (Asc), in a large adult colonoscopy patient population Methods: Three multicenter, randomized, colonoscopist-blinded parallel group studies in males/females (18-85 years) are underway. Main inclusion criteria: screening, surveillance or diagnostic colonoscopy patients. Main exclusion criteria include: history (≤12 months) or current severe constipation episode; known/suspected ileus; gastrointestinal (GI) obstruction; gastric retention; bowel perforation; toxic colitis or megacolon; ongoing severe acute inflammatory bowel disease; previous significant GI surgeries. NOCT (NCT02254486) will randomize (1:1) ≤620 US patients to NER1006 (2-day split dosing starting evening of the day before colonoscopy) or trisulfate solution (per label). MORA (NCT02273167; 2014-002185-78) will randomize (1:1:1) ≤850 European patients to NER1006 (2-day evening/morning splitdosing and 1-day morning on day of colonoscopy) or PEG3350+Asc (per label). DAYB (NCT02273141; 2014-002186-30) will randomize (1:1) ≤530 European patients to NER1006 (1-day, day before-only split dosing starting evening of the day before colonoscopy) or sodium picosulfate/magnesium salt (per label). Study duration: ≤4 clinic visits/patient for ≤40 days. Alternative primary endpoints: 1. NER1006 overall bowel cleansing success rate is non-inferior to comparator using the Harefield Cleansing Scale (HCS); 2. NER1006 ‘Excellent plus Good' cleansing rate in colon ascendens is non-inferior to comparator using HCS segmental cleansing scoring system. Central readers will score colonoscopy videos. Key secondary endpoints include: adenoma and polyp detection rates in colon ascendens and overall. Results: As of May 2015, number of patients randomized were: 610/620 at 12 US sites (NOCT); 507/850 at 30 sites in Belgium, France, Germany, Italy, Poland, Spain and UK (MORA); 369/530 at 20 sites in Germany, Italy, Netherlands, Poland, Spain, and UK (DAYB). Studies are due to complete by September 2015. Conclusion: Quality of bowel preparation is an important factor for a successful colonoscopy but lavage solution volume required to achieve efficacy/tolerability is often a barrier. Findings from these pivotal Phase 3 studies of a new low-volume bowel preparation may provide a better understanding of what is required in an optimal bowel preparation.

Comparison of three oral regimens with compound polyethylene glycol electrolyte for bowel preparation

Objective To evaluate the effects of three methods with oral compound polyethylene glycol electrolyte powder. Methods A total of 180 patients scheduled for colonoscopy were prospectively randomized into three groups, group A (n=67), group B (n=54) and group C (n=59), which received 4-L split-dose PEG, 3-L split-dose PEG and 4-L whole-dose PEG, respectively. The colon cleansing quality, the access time and polyp detection were evaluated. Results The access times of the 3 groups were(10.07±5.219)min, (10.19±4.903)min and (11.05±5.306)min, respectively, which had no significant differences (P>0.05). However, in terms of the quality of colon cleansing, group A was superior to group B, and there was significant difference in the scores of recto-sigmoid colon, mid colon, right colon, total fluid quantity as well as total score between the two groups(P 0.05). Conclusion 4-L split-dose PEG is better than the other 2 regimens in the colon cleansing quality, so it can better reach the intestinal cleaning standards before enteroscopy, which is a more suitable regimen for bowel preparation. Key words: Colonoscopy; Compound polyethylene glycol electrolyte power; Bowel preparation

Split-Dose Preparations Are Superior to Day-Before Bowel Cleansing Regimens: A Meta-analysis

There are different regimens of preparing the colon for colonoscopy, including polyethylene glycol (PEG), sodium phosphate, picosulfate, or oral sulfate solutions. We performed a meta-analysis to determine the efficacy of split-dose vs other colon preparation regimens, the optimal products for use, and the most effective preparation volumes. We performed systematic searches of MEDLINE, EMBASE, Scopus, CENTRAL, and ISI Web of knowledge databases, from January 1980 to March 2014, for published results from randomized trials that assessed split-dose regimens vs day-before colonoscopy preparation. We excluded studies that included pediatric or hospitalized patients, or patients with inflammatory bowel disease. The primary outcome was efficacy of bowel cleansing. Secondary outcomes included side effects or complications, outcomes of procedures, patients' willingness to repeat the procedure, and the amount of time required for patients to resume daily activities. We identified 47 trials that fulfilled our inclusion criteria (n = 13,487 patients). Split-dose preparations provided significantly better colon cleansing than day-before preparations (odds ratio [OR], 2.51; 95% confidence interval, 1.86-3.39), as well as day-before preparations with PEG (OR, 2.60; 95% confidence interval, 1.46-4.63), sodium phosphate (OR, 9.34; 95% confidence interval, 2.12-41.11), or picosulfate (OR, 3.54; 95% confidence interval, 1.95-6.45). PEG split-dose preparations of 3 L or more yielded greater bowel cleanliness than lower-volume split-dose regimens (OR, 1.89; 95% confidence interval, 1.01-3.46), but only in intention-to-treat analysis. A higher proportion of patients were willing to repeat split-dose vs day-before cleansing (OR, 1.90; 95% confidence interval, 1.05-3.46), and low-volume split-dose preparations vs high-volume split-dose preparation (OR, 4.95; 95% confidence interval, 2.21-11.10). There were no differences between preparations in other secondary outcome measures. However, there was variation among studies in definitions and main and secondary outcomes. Based on meta-analysis, split-dose regimens increase the quality of colon cleansing and are preferred by patients compared with day-before preparations. Additional research is required to evaluate oral sulfate solution-based and PEG low-volume regimens further.

Cost-Analysis Model of Colonoscopy Preparation Using Split-Dose Reduced-Volume Oral Sulfate Solution (OSS) and Polyethylene Glycol With Electrolytes Solution (PEG-ELS)

Cost-Analysis Model of Colonoscopy Preparation Using Split-Dose Reduced-Volume Oral Sulfate Solution (OSS) and Polyethylene Glycol With Electrolytes Solution (PEG-ELS)

Staining of Proximal Flat Polyps by Indigo Carmine Delivered by Oral Polyethylene Glycol Bowel Preparation: A Prospective, Open Label Pilot Study

Introduction: Indigo carmine (IGC) applied to the colonic mucosa during colonoscopy has been shown to increase detection of flat polyps, but the process is time consuming. Oral IGC can simplify the process for the colonoscopist. However, it is not known if oral IGC reaches the colon at sufficient concentrations to provide adequate staining; 0.008% is the lowest concentration used topically. We aim to evaluate the effectiveness of oral IGC delivered by a polyethylene glycol (PEG) solution for staining of flat polyps in the right colon. Methods: Patients presenting for screening and surveillance colonoscopy were enrolled. Initial concentration of IGC used was 0.008% (160 mg per 2 L). This was increased in a stepwise fashion after 3 consecutive colonoscopies to 0.064% (320 mg per 500 mL). Distribution of staining in 3 colonic segments was graded as: no staining=0, staining <50% of mucosa=1, staining >50%=2, staining >80%=3. Intensity of staining was graded as: none=0, poor=1, fair=2, good=3. Results: Fifteen patients completed the study. At 320 mg dose (n=9), 62.5% of patients had ≥50% distribution of staining in the right colon. Intensity of staining was fair in all segments in 87.5% of the patients (Table 1). Flat polyps were accentuated in some patients (Figure 1), and pooling of stained liquid indicated that sufficient dye reached the proximal colon.Figure 1Table 1Conclusion: At the highest allowable FDA dose, a majority of the patients achieved adequate staining of the mucosa in the right colon. Flat polyps were seen even in segments without obvious staining. This pilot study confirms the feasibility of using oral IGC delivered by a PEG solution to provide staining of the proximal colon.

Stimulation of colonic motility by oral PEG electrolyte bowel preparation assessed by MRI: comparison of split vs single dose.

BackgroundMost methods of assessing colonic motility are poorly acceptable to patients. Magnetic resonance imaging (MRI) can monitor gastrointestinal motility and fluid distributions. We predicted that a dose of oral polyethylene glycol (PEG) and electrolyte solution would increase ileo-colonic inflow and stimulate colonic motility. We aimed to investigate the colonic response to distension by oral PEG electrolyte in healthy volunteers (HVs) and to evaluate the effect of single 2 L vs split (2 × 1 L) dosing.MethodsTwelve HVs received a split dose (1 L the evening before and 1 L on the study day) and another 12 HVs a single dose (2 L on the main study day) of PEG electrolyte. They underwent MRI scans, completed symptom questionnaires, and provided stool samples. Outcomes included small bowel water content, ascending colon motility index, and regional colonic volumes.Key ResultsSmall bowel water content increased fourfold from baseline after ingesting both split (p = 0.0010) and single dose (p = 0.0005). The total colonic volume increase from baseline was smaller for the split dose at 35 ± 8% than for the single dose at 102 ± 27%, p = 0.0332. The ascending colon motility index after treatment was twofold higher for the single dose group (p = 0.0103).Conclusions & InferencesIngestion of 1 and 2 L PEG electrolyte solution caused a rapid increase in the small bowel and colonic volumes and a robust rise in colonic motility. The increase in both volumes and motility was dose dependent. Such a challenge, being well-tolerated, could be a useful way of assessing colonic motility in future studies.

PWE-107 Accuracy Of Magnetic Resonance Enterograpgy In Predicting Anastomotic Stenosis In Recurrent Crohn’s Disease

IntroductionUp to 80% of patient with Crohn’s disease (CD) undergo intestinal resection, commonly an ileocaecal resection. Eighty percent of patients develop endoscopic recurrence at the anastamotic site at 1 year...

A randomized, controlled trial of oral sulfate solution plus polyethylene glycol as a bowel preparation for colonoscopy

No bowel preparation for colonoscopy is optimal with regard to efficacy, safety, and tolerability. New options for bowel preparation are needed. To compare a new hybrid preparation consisting of a reduced dose of oral sulfate solution (OSS) plus 2 L of sulfate-free electrolyte lavage solution (SF-ELS) with 2 low-volume preparations based on polyethylene glycol electrolyte lavage solution (PEG-ELS). Two randomized, controlled trials. Twenty-four U.S. centers. A total of 737 outpatients undergoing colonoscopy. In study 1, OSS plus SF-ELS was given as a split dose, and in study 2, OSS plus SF-ELS was given in its entirety the evening before colonoscopy. In study 1, the active control was 2 L of PEG-ELS plus ascorbic acid (PEG-EA) given as a split dose. In study 2, the control was 10 mg of bisacodyl plus 2 L of SF-ELS taken the evening before colonoscopy. Rates of successful (good or excellent) bowel preparation. In study 1, the rates of successful (excellent or good) preparation with OSS plus SF-ELS and PEG-EA were identical at 93.5% for split-dose preparation. OSS plus SF-ELS was noninferior to PEG-EA (P< .001). In study 2, OSS plus SF-ELS resulted in successful preparation in 89.8% of patients compared with 83.5% with bisacodyl plus SF-ELS in a same-day preparation regimen. OSS plus SF-ELS was noninferior to bisacodyl plus SF-ELS (P<.001). In study 1, vomiting was more frequent with OSS plus SF-ELS (13.5% vs 6.7%; P= .042), and bloating was rated worse with PEG-EA (P= .025). In study 2, overall discomfort was rated worse with OSS plus SF-ELS (mean score 2.1 vs 1.8; P= .032). There were no deaths in either study and no serious adverse events considered related to the preparation. Bowel cleansing was not scored by colon segment. Adenoma detection was not compared between the regimens. OSS plus SF-ELS is a new, safe, and effective bowel preparation for colonoscopy.

Index of Suspicion

* ALT: : alanine aminotransferase AST: : aspartate aminotransferase BUN: : blood urea nitrogen CBC: : complete blood count CNS: : central nervous system CSF: : cerebrospinal fluid CT: : computed tomography ECG: : electrocardiography ED: : emergency department EEG: : electroencephalography ESR: : erythrocyte sedimentation rate GI: : gastrointestinal GU: : genitourinary Hct: : hematocrit Hgb: : hemoglobin MRI: : magnetic resonance imaging WBC: : white blood cell An 11-year-old boy presents to the emergency department with a 1-week history of frequent episodes of nonbloody, nonbilious emesis associated with diarrhea and abdominal cramping. He has urgency and fecal incontinence. He has been afebrile and denies any rashes, joint pain, sick contacts, headaches, or other symptoms. On further questioning, his mother reveals that he has had 2 similar episodes of abdominal distension and diarrhea during the past 6 to 7 years. Between these episodes, she states that he normally has nonbloody, hard stools accompanied by straining and chronic abdominal pain and pain with defecation. When asked specifically, his mother does not remember when he passed his first stool after he was born. On physical examination, his temperature is 37.6°C, pulse is 100 beats per minute, respiratory rate is 16 breaths per minute, blood pressure is 113/62 mm Hg, oxygen saturation is 100% on room air, height is 63 inches (95%), and weight is 36.7 kg (25%). He has abdominal distention and diffuse abdominal tenderness with voluntary guarding. There is palpable stool in the left quadrant. There is no perianal erythema or skin tag, and rectal examination reveals a low anal tone. A CT scan of the abdomen (Figure 1) reveals a markedly distended rectosigmoid colon with circumferential, confluent, and contiguous mural thickening. Basic metabolic profile, CBC, and urinalysis results are unremarkable, but the C-reactive protein level is elevated at 131 mg/L (1248 nmol/L). Because of the concern for enterocolitis, he is empirically given broad-spectrum intravenous antibiotics and transferred to a children’s hospital for further evaluation. Figure 1. A CT scan of the abdomen shows a markedly distended rectosigmoid colon with circumferential mural thickening. A 4-year-old boy presents for evaluation of intermittent fevers of 4 weeks’ duration after 2 separate antibiotic courses prescribed for acute otitis media. He has experienced clear rhinorrhea and …

Enterografia por tomografia computadorizada: uma avaliação de diferentes contrastes orais neutros

OBJETIVO: O objetivo deste estudo foi avaliar o desempenho de contrastes orais neutros, comparando a capacidade de distensão intestinal, a distinção da parede intestinal, a aceitação e os efeitos colaterais. MATERIAIS E MÉTODOS: Estudo prospectivo, randomizado e duplo-cego em 30 pacientes submetidos a tomografia computadorizada de abdome e pelve com administração de contraste oral neutro, divididos em três grupos: leite, água e polietilenoglicol. Os exames foram analisados quanto ao grau de distensão intestinal e distinção da parede intestinal por dois examinadores em consenso. Os pacientes responderam a um questionário referente ao sabor da solução ingerida e efeitos colaterais. Foram utilizados os testes Kruskal-Wallis e qui-quadrado para as análises estatísticas. RESULTADOS: Distensão intestinal adequada (calibre da alça maior que 2 cm) foi observada em 14 segmentos dos 40 estudados (35%) no grupo leite, em 10 segmentos (25%) no grupo água e em 23 segmentos (57%) no grupo polietilenoglicol (p = 0,01). O preparo com polietilenoglicol resultou na melhor distensão intestinal, porém apresentou o pior sabor e maior incidência de diarreia, referidos pelos pacientes. CONCLUSÃO: O preparo oral com polietilenoglicol promove maior grau de distensão intestinal do que quando se utiliza água ou leite, mas tem pior aceitação, relacionada ao seu sabor e frequência de diarreia.

Empty colon: a pitfall in the assessment of colonic transit time

We report a misleading outcome of colonic transit time (CTT) assessment in an adolescent girl with functional constipation. We found prolonged total and right segmental CTT despite high doses of oral polyethylene glycol 4000 and repeated treatment with polyethylene glycol–electrolyte solution (Klean-Prep®) by nasogastric tube. A colonoscopy aiming at disimpaction of a possible faecal mass revealed an empty colon with dozens of radio-opaque markers adhered to the colonic wall. This report shows that the result of a CTT cannot be accepted blindly. Especially the clustering of many markers within narrow margins might point at entrapment of markers in mucus against the colonic wall.