Psyllium Fiber Research Articles

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

The effect of psyllium (Plantago ovata Forsk) fibres on the mechanical and physicochemical characteristics of plant-based sausages.

Psyllium is a source of natural dietary fibre with recognised health benefits that can be used as a hydrocolloid with functional food applications. The purpose of this study was to determine the effect of different levels of Plantago ovata fibres in plant-based sausages on their composition, physicochemical, and mechanical properties. Proximate composition was studied. Water activity (aw), water release, pH, colour measurement, texture profile analysis (TPA), and Warner–Bratzler Shear Force (WBSF) were determined to establish the physicochemical and textural properties of sausages. A plant-based sausages microstructure study and a sensory study were carried out to better understand conformation and to determine their acceptance. The results showed that sausages had high ash and carbohydrate contents but, above all, a low-fat content. The use of psyllium increased water-holding capacity. The results also indicated that employing Plantago ovata white (PW) fibre can minimise mechanical problems and reduce colour changes. However, PW fibre showed less retained water, which was why chickpea starch further developed and was more gelatinised. At the same time, the plant-based sausages with PW fibre obtained the best overall score with the fewest colour changes in the sensory evaluation. Nevertheless, further studies are recommended to improve the texture and acceptability of these plant-based sausages.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00217-022-04063-2.

Micronutrient status of individuals with overweight and obesity following 3\xa0months\u2019 supplementation with PolyGlycopleX (PGX\xae) or psyllium: a randomized controlled trial

BackgroundSafe and effective weight control strategies are needed to curtail the current obesity epidemic worldwide. Increasing dietary fibre has shown positive results with weight loss as well as in the reduction of metabolic syndrome risk factors. However, fibre can act as an inhibitor to the bioavailability of micronutrients in the gastrointestinal tract. While there is a substantial amount of scientific research into psyllium fibre, PolyGlycopleX (PGX®) is a novel fibre and as yet the effects of PGX® on micronutrient status is not well researched.AimTo determine whether 3-months’ supplementation with 15 g of psyllium or PGX® fibre daily affects micronutrient status of overweight and obese adults.MethodsOverweight and obese individuals with a BMI between 25–40 kg/m2 and aged between 18 and 65 years, but otherwise healthy, were instructed to consume a 5 g sachet of psyllium, PGX® fibre or a rice flour placebo three times a day for 52 weeks as part of a larger long-term study. Blood sample data for the first 3 months were analysed for associations between serum micronutrient levels and psyllium fibre and/or PGX® supplements.ResultsNo significant differences between fibre supplement groups and micronutrient status were found after 3 months at p > 0.05. Dietary intake of vitamin C was significantly lower for PGX® at 3 months compared to baseline and compared to control (p < 0.05). Folate was significantly lower in the control group after 3 months (p < 0.05). In the psyllium group, folate, sodium, zinc and magnesium intake decreased after 3 months (p < 0.05). A limitation of dietary intake data (tertiary measure) is the potential for inaccurate self-reporting, although reduced nutrient intake could be due to the satiating effect of dietary fibre.ConclusionsThere were no significant between group differences in serum micronutrient concentrations after a 3-month psyllium fibre or PGX® supplementation intervention of 15 g per day. Fibre supplementation is unlikely to compromise the nutritional status of overweight and obese individuals in the short term. Further research is recommended to monitor micronutrient status over a longer period or with a higher fibre dosage.

Are Psyllium Fiber and Flaxseed Flour An Exciting Combination of Ingredients in the Development of Gluten-free Vegan Bread?

ABSTRACT Gluten substitution in baking generally generates products with low sensory and nutritional quality; therefore, the research for a substitute that mimics gluten’s structural characteristics and improves the dietary attributes of bread is interesting. The removal of eggs from gluten-free baking products to make them vegan is another challenge. It helps in various factors such as taste, structure, air incorporation, and specific volume. The present study evaluates the combination of psyllium fiber and flaxseed as gluten and egg substitutes in gluten-free, vegan bread. The volume, color, texture, internal crumb structure, sensory, and nutrient composition were evaluated. The bread with flaxseed and psyllium fiber was classified as protein and fiber sources. Sensory analysis showed that bread with 1.5% of Psyllium fiber and 7.5% of flaxseed flour presented an acceptance index above 70%. Also, this combination of ingredients generates many small pores minimizing the firmness increase during storage.

Okra (Abelmoschus esculentus) Powder Production and Application in Gluten-Free Bread: Effect of Particle Size

Okra (Abelmoschus esculentus) has interesting nutritional and technological properties and is naturally gluten-free (GF). This study investigated the physicochemical properties of okra powder obtained by a low-temperature drying process and its impact on GF bread. Its potential synergy with other hydrocolloids (i.e., hydroxypropylmethylcellulose (HPMC) and Psyllium fibre (Psy)) was also studied. As the importance of powder particle size in food design is well known, whole okra powder (WOP; ≤ 1000 µm) and fine okra powder (FOP; ≤ 250 µm) were produced. Compared to the standard formulation, WOP and FOP doughs required less water to reach the desired dough consistency (200 ± 20 Brabender unit) and generally showed higher stability during mixing. Dough development was affected by HPMC more than okra powder particle size. Breads containing WOP or FOP in combination with HPMC exhibited high specific volume and soft texture, while the combination with Psy resulted in a less-developed, harder and darker bread. The combination with HPMC also guaranteed a longer shelf-life, regardless of okra powder particle size. These results may prove useful for the agri-food industry, as they demonstrate that okra can be used as an innovative natural hydrocolloid.

Development of dietary fiber psyllium based hydrogel for use in drug delivery applications

Keeping in view the therapeutic and gel forming role of the psyllium seed mucilage in pharmaceutical industries, herein this article, its potential has been explored for developing the drug delivery (DD) carrier. The main aim of the study was to modify the psyllium polysaccharides through grafting and crosslinking of 2-methacryloyloxyethyl trimethylammonium chloride onto psyllium to develop the hydrogels for use in DD application. Various thermal, mechanical, physiochemical, biomedical properties of the hydrogel were determined along with characterization with 13C NMR, FTIR, XRD, TGA, DSC and AFM. The release of antibiotic drug cefuroxime occurred in sustained manner and followed Fickian diffusion mechanism and was best fitted in Higuchi kinetic model. The networks showed mesh size in the range between 25.14 to 38.92 nm during the change in crosslinker content in copolymerization reaction. It has been inferred from the results that these hydrogels could be used as a potential carrier for drug delivery.

Synthesis and characterization of arabinoxylan-bis[2-(methacryloyloxy)ethyl] phosphate crosslinked copolymer network by high energy gamma radiation for use in controlled drug delivery applications

Keeping in view the therapeutic important dietary fiber psyllium, herein this research report its potential has been explored for the formation of sterile hydrogel by high energy radiation induced copolymerization of arabinoxylan-poly bis[2-(methacryloyloxy)ethyl] phosphate (BMEP) for use as drug delivery carrier. The polymeric network structure was characterized by 13C NMR, FTIR, TGA/DTG and DSC, XRD and AFM techniques. Release profile of a drug cefuroxime and best fit kinetic model were determined. The blood –polymer interaction, mucosal-polymer adhesion, antioxidant and mechanical properties were also evaluated. The radiation dose influenced the crosslink density and the mesh size of the hydrogel network. Release profile of a drug cefuroxime followed non-Fickian diffusion and best fitted to first order kinetic model. The grafted product was sterile, porous, antioxidant and mucoadhesive in nature and could be explored for controlled and sustained GIT drug delivery applications.

Correction of eating habits in patients with carbohydrate metabolism disorders

The International Diabetes Federation estimates that approximately 10% of the adult population in Ukraine has prediabetes. According to many studies, prediabetes is observed in every second obese patient, and later prediabetes can progress to type 2 diabetes mellitus. Therefore, timely detection of early disorders of carbohydrate metabolism is very important, as well as implementation of recommendations for lifestyle changes, the use of modern drugs to prevent type 2 diabetes and cardiovascular diseases. In recent years, increasing attention is drawn to dietary fibers as an integral part of a healthy diet. They help prevent obesity, metabolic syndrome and adverse changes in the gut, and also help increase the population of beneficial bacteria in the gut. That is why nutritionists recommend that obese people include dietary fibers in their diet. One of the most famous dietary fibers is psyllium, which comes from the husk of plantain seeds (Plantago ovata). Numerous studies show that psyllium has a positive effect on the functioning of many organs and systems, including the pancreas, intestines and heart muscle. Psyllium also lowers glucose and cholesterol and is an effective way to lose weight for people who are overweight. Fibolex® plant complex contains dietary fibers (psyllium and natural wheat fibers) and green tea extract. Due to the combined herbal composition, Fibolex® can be used in obese people, patients with prediabetes, metabolic syndrome, type 2 diabetes and other metabolic disorders for the correction of eating habits in order to improve carbohydrate and lipid metabolism.

Effects of psyllium fiber on in vitro digestion and structure of different types of starches.

Starch digestibility in foods strongly depends on the structure, other ingredients and processing conditions used. This study aimed to investigate the effect of psyllium fiber on gelatinization, crystallinity and in vitro digestibility of starches having different crystalline structures (A, B and C). Wheat, potato and tapioca starches with and without added psyllium fiber were heated at 90 °C for 10min at three different solid:water (w:v) ratios (1:1, 1:2 and 1:5). The added fiber content was 50% (dry base) in the solid fraction for the fiber-added samples. Wheat, potato and tapioca starches showed different structural, morphological and starch digestibility properties. The effect of cooking and fiber addition on starch digestion differed for the starch types, mainly wheat starch. Psyllium addition during cooking decreased the rapidly digestible starch (RDS) fractions while increasing the slowly digestible starch (SDS) and remaining/resistant starch (RS) fractions. The effect of psyllium fiber addition was not limited to restricting the swelling and gelatinization of starch granules during heating. Psyllium fiber effectively restricted the mobility of digestive enzymes during digestion. Understanding the relationship between psyllium and starch digestibility for different types of starch could assist in designing food formulations with lower starch digestibility. These in vitro data, however, should be confirmed by in vivo studies. © 2021 Society of Chemical Industry.

Effectiveness of Medicinal Plants for Glycaemic Control in Type 2 Diabetes: An Overview of Meta-Analyses of Clinical Trials.

Aims: To rank the effectiveness of medicinal plants for glycaemic control in Type 2 Diabetes (T2DM). Methods: MEDLINE, EMBASE, CINAHL and Cochrane Central were searched in October 2020. We included meta-analyses of randomised controlled clinical trials measuring the effectiveness of medicinal plants on HbA1c and/or Fasting Plasma Glucose (FPG) in patients with T2DM. Results: Twenty five meta-analyses reported the effects of 18 plant-based remedies. Aloe vera leaf gel, Psyllium fibre and Fenugreek seeds had the largest effects on HbA1c: mean difference –0.99% [95% CI−1.75, −0.23], −0.97% [95% CI −1.94, −0.01] and −0.85% [95% CI −1.49, −0.22] respectively. Four other remedies reduced HbA1c by at least 0.5%: Nigella sativa, Astragalus membranaceus, and the traditional Chinese formulae Jinqi Jiangtang and Gegen Qinlian. No serious adverse effects were reported. Several other herbal medicines significantly reduced FPG. Tea and tea extracts (Camellia sinensis) were ineffective. However, in some trials duration of follow-up was insufficient to measure the full effect on HbA1c (<8 weeks). Many herbal remedies had not been evaluated in a meta-analysis. Conclusion: Several medicinal plants appear to be as effective as conventional antidiabetic treatments for reducing HbA1c. Rigorous trials with at least 3 months’ follow-up are needed to ascertain the effects of promising plant-based preparations on diabetes.

Effects of psyllium and cellulose fibres on thermal, structural, and in vitro digestion behaviour of wheat starch

SummaryThe study investigated the effects of adding different types of fibre (psyllium and cellulose) on in vitro digestion behaviour of wheat starch with its thermal and structural properties. Psyllium and cellulose fibres interfered with the wheat starch differently. Psyllium fibre hindered starch gelatinisation, restricted the loss of starch crystallinity, and decreased the accessibility of enzymes to starch. In contrast, cellulose fibre had no significant effect on gelatinisation and loss of crystallinity but limited the digestive enzyme mobility. The impact of psyllium was more pronounced than cellulose on reducing starch digestibility. Rapidly digestible starch fractions of the cooked starch reduced from between 57.90 ± 0.60–69.72 ± 0.46 (% in starch) to between 28.06 ± 0.36–46.34 ± 1.10 (% in starch) and 53.23 ± 0.36–66.71 ± 0.24 (% in starch) for psyllium and cellulose fibre, respectively. This information could be helpful to design foods containing starch with reduced digestibility for a healthy diet.

Effect of psyllium fiber addition on the quality of Arabic flatbread (Pita) produced in a commercial bakery

Psyllium husk (Plantago ovata Forssk.), is an excellent source of natural soluble fiber. Arabic flatbread formulation standardized in a laboratory was scaled up for production in a commercial bakery. The water holding capacity (WHC) of wholegrain wheat flour (WGF), white wheat flour (WWF) and psyllium husk (PS) were found to be 2.9, 2.3 and 59.2 g water/g dry matter, respectively. The total dietary fiber (TDF) for WWF control bread (3.20 ± 0.23%) increased significantly to 5.62 ± 0.16 and 7.56 ± 0.18% with the addition of 3% and 5% psyllium, respectively. The corresponding soluble dietary fiber (SDF) values for these samples were 1.31 ± 0.13, 3.02 ± 0.16 and 4.15 ± 0.14%, respectively. The WWF Arabic flatbread samples also followed a similar trend for TDF and SDF contents with the addition of psyllium husk. At a level of 5% psyllium, the WWF test bread had a puncture force of 2.97 ± 0.16 N (much softer) compared with 3.40 ± 0.35 N for the WWF control bread (0% psyllium), whereas the WGF with 5% psyllium addition had a puncture force of 3.05 ± 0.19 N at the zero day of storage compared to that of 3.94 ± 0.19 N for WGF bread with no psyllium added. The major objective of this study was not only to enhance the soluble dietary fiber content in Arabic flatbread, but also to improve the consumer acceptability of this staple food of this region. Incorporation of psyllium husk did not adversely affect the objective color of crumb or overall consumer acceptability, and produced Arabic flatbread with softer texture, better flexibility (folding) and superior eating quality.

Developing psyllium fibre gel-based foods: Physicochemical, nutritional, optical and mechanical properties

Psyllium fibre has known health benefits, which are highly related to its gelling properties, so it is important to know the functional properties and its gelling capacity to its possible incorporation as a new source of DF in foods. Therefore, the purpose of this research was to evaluate these properties of two Psyllium fibres. Physicochemical (particle size distribution, pH, water content, water activity, hygroscopicity and bulk density and porosity), hydration (water holding, water retention and swelling capacity, fat absorption capacity and solubility), and nutritional properties (mineral content, total phenolics compounds and antioxidant capacity) of dietary fibre (DF) samples were recorded. Moreover, physicochemical (water content, pH and colour) and mechanical properties (back extrusion test, rheological measurement and texture profile analysis) of gel samples were performed before and after heat treatment (20 min at 65 °C). The hydration properties of Plantago Husk (PH) were higher than those in Plantago Powder (PP), but in functional terms, high values of phenols and antioxidant activity were found in PP. However, both samples displayed similar gelling properties. As a result of the rheological and textural analysis, both fibres showed good gelling properties at both high (65 °C) and cool (5 °C) temperatures, at concentrations 4%–7%. Moreover, the results indicate that PH and PP have suitable characteristics to be functional ingredients, which can help to avoid possible negative effects on food sensory and structural characteristics.

Inflammation in Irritable Bowel Syndrome (IBS): Role of Psyllium Fiber Supplementation in Decreasing Inflammation and Physiological Management of IBS.

Inflammation in Irritable Bowel Syndrome (IBS): Role of Psyllium Fiber Supplementation in Decreasing Inflammation and Physiological Management of IBS.

Diarrhea in tube-fed hospitalized patients: Feeding formula is not the most common cause.

Clostridium difficile-associated diarrhea (CDAD) and enteral nutrition (EN)-associated diarrhea are the most common recognized etiologies of nosocomial diarrhea. However, in clinical practice, the data regarding how each etiology contributes to the diarrheal episodes are limited. We identify the causes and factors associated with post-feeding diarrhea. Using the data of patients enrolled in "Effect of Psyllium Fiber Supplementation on Diarrhea Incidence in Enteral Tube-Fed Patients: A Prospective, Randomized, and Controlled Trial", the randomized controlled trial showed no difference in diarrheal incidences between fiber-added and fiber-free formulas. Hence, we analyzed the data of all enrolled patients. The causes of diarrhea were classified according to pre-specified definitions. The factors associated with diarrhea were analyzed using logistic regression. Diarrhea was found in 37.3% (n=31/83). The most common cause was medication associated (61.3%). CDAD and EN-associated diarrhea were found in only 9.7% and 6.5%, respectively. Patients with baseline albumin <3g/dL and underlying cerebrovascular disease were more likely to develop diarrhea (adjusted odds ratio 5.70, 95% confidence interval 1.79-20.51, and adjusted odds ratio 10.83, 95% confidence interval 2.96-48.57, respectively). Compared with those without diarrhea, the length of hospital stay in CDAD patients was significantly longer (+23.1days, P=0.02), a trend of longer hospital stay in patients with diarrhea from other causes was observed (+3.2days, P=0.096). Our study found that the most common cause of post-feeding diarrhea is medication associated. Review and cessation of possible drugs should be undertaken before EN modification. CDAD accounts for <10% of diarrhea causes, but it impacts the clinical outcome and should be identified and treated properly.

Silver-containing polysaccharide-based tricomponent antibacterial fibres for wound care applications.

Polysaccharide-based biomaterials are extensively used in wound care healing due to their unique liquid absorption, gelling properties and biocompatibility properties. They play an important role in controlling infections of highly exuding hard-to-heal wounds. The main objective of this study was to develop silver-containing polysaccharide-based tricomponent antibacterial fibres for use in these complex wounds. The fibres were developed by coating silver-containing alginate and psyllium fibres with hydrolysed chitosan. Dope solution containing alginate, psyllium and silver carbonate was extruded into a coagulation bath containing calcium chloride and hydrolysed chitosan. The developed fibres were tested for liquid absorption, swelling and antibacterial properties against a control fibre (of alginate and psyllium). The developed fibres showed comparatively better liquid absorption, gelling and antibacterial properties than the control fibres. The study concluded that developed fibres could be a preferred choice for application on hard-to-heal wounds with high levels of exudate, to support infection control and faster healing.

Nurse- and Pelvic Floor Physical Therapist-Led Bowel Training in Patients With Fecal Incontinence in a Tertiary Care Center.

Little is known about nurse- and pelvic floor physical therapist-led bowel training in fecal incontinence after previous conservative management has been deemed unsatisfactory. The objective of this study was to evaluate combined nurse- and physical therapist-led bowel training sessions in a tertiary care center. This was a prospective, cross-sectional study. All patients with fecal incontinence between 2015 and 2016 with and without previous conservative management were included. Combined conservative treatment was defined as the use of stool-bulking agents (psyllium fibers) with or without antidiarrheal medication (loperamide) in combination with biofeedback or pelvic floor muscle training. Questionnaires regarding fecal incontinence (Vaizey incontinence score) and quality of life (Short Form Health Survey-36) were used. A decrease in the Vaizey incontinence score of 5 or more points was deemed to be clinically significant. Vaizey incontinence scores in all 50 patients decreased from 14.7 (SD = 4.5) to 9.9 (SD = 4.8) at follow-up (p < .001). Forty percent of patients reported an improvement in their Vaizey incontinence score (change of 5 or more points). Improvement was noted in those with and without previous treatment. Quality of life improved significantly. The limitation of the study includes lack of a standardized treatment protocol. Fecal incontinence reduced after nurse- and physical therapist-led bowel training sessions in patients with and without previous treatment, increasing their quality of life.

Simulator-based ultrasound training for identification of endotracheal tube placement in a neonatal intensive care unit using point of care ultrasound

BackgroundSimulators are an extensively utilized teaching tool in clinical settings. Simulation enables learners to practice and improve their skills in a safe and controlled environment before using these skills on patients. We evaluated the effect of a training session utilizing a novel intubation ultrasound simulator on the accuracy of provider detection of tracheal versus esophageal neonatal endotracheal tube (ETT) placement using point-of-care ultrasound (POCUS). We also investigated whether the time to POCUS image interpretation decreased with repeated simulator attempts.MethodsSixty neonatal health care providers participated in a three-hour simulator-based training session in the neonatal intensive care unit (NICU) of Aga Khan University Hospital (AKUH), Karachi, Pakistan. Participants included neonatologists, neonatal fellows, pediatric residents and senior nursing staff. The training utilized a novel low-cost simulator made with gelatin, water and psyllium fiber. Training consisted of a didactic session, practice with the simulator, and practice with intubated NICU patients. At the end of training, participants underwent an objective structured assessment of technical skills (OSATS) and ten rounds of simulator-based testing of their ability to use POCUS to differentiate between simulated tracheal and esophageal intubations.ResultsThe majority of the participants in the training had an average of 7.0 years (SD 4.9) of clinical experience. After controlling for gender, profession, years of practice and POCUS knowledge, linear mixed model and mixed effects logistic regression demonstrated marginal improvement in POCUS interpretation over repeated simulator testing. The mean time-to-interpretation decreased from 24.7 (SD 20.3) seconds for test 1 to 10.1 (SD 4.5) seconds for Test 10, p < 0.001. There was an average reduction of 1.3 s (β = − 1.3; 95% CI: − 1.66 to − 1.0) in time-to-interpretation with repeated simulator testing after adjusting for the covariates listed above.ConclusionWe found a three-hour simulator-based training session had a significant impact on technical skills and performance of neonatal health care providers in identification of ETT position using POCUS. Further research is needed to examine whether these skills are transferable to intubated newborns in various health settings.Trial registrationClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.

Abstract 3461: Psyllium protects against high fructose diet induced exacerbation of colitis and colitis associated colorectal carcinogenesis

Abstract Patients with longstanding Inflammatory Bowel Disease, including ulcerative colitis and Crohn's disease, are at an increased risk of developing colorectal cancer (CRC). Over the past three decades, there has been a significant increase in the consumption of fructose, a monosaccharide that has been linked to increased growth of experimental intestinal tumors. Additionally, recent evidence shows that feeding a diet high in fructose worsens acute experimental colitis. The aims of the current study were to 1) determine if a high fructose diet (HFrD) exacerbated chronic colitis in mice and led to enhanced colorectal tumorigenesis and 2) evaluate the potential chemopreventive properties of dietary fiber in this context. To carry this out, the azoxymethane (AOM)/DSS model of colitis-associated colorectal neoplasia was utilized in male C57BL/6J mice. In comparison to control AIN93G diet, an isocaloric diet supplemented with fructose led to worse chronic colitis including weight suppression, worse diarrhea, colon shortening and a higher histologic score. Tumor incidence, number and size were all increased (Ps&amp;lt;0.001) in the HFrD compared to control diet group. Because eliminating fructose from the diet is impractical, it is important to identify other potential dietary constituents that may minimize its harmful effects. Dietary fiber has been suggested to be beneficial for reducing the severity of colitis. Therefore, we next determined whether the severity of HFrD-associated acute colitis was altered by dietary psyllium, pectin, inulin or cellulose fibers. In comparison to the other three fibers, psyllium protected against acute DSS- induced colitis. It also led to a significant shift in the fecal microbiota. Finally, we tested whether psyllium would attenuate the worsening of chronic colitis and colitis-associated colorectal neoplasia mediated by HFrD. Using the AOM/DSS model, we found that psyllium fiber protected against the exacerbation of chronic colitis mediated by HFrD with improved diarrhea, bleeding and histologic score. Consistent with its ability to suppress HFrD-mediated exacerbation of chronic colitis, psyllium markedly suppressed the increase in colorectal tumor incidence, number and size in mice that received the HFrD. Taken together, these results indicate that feeding a HFrD exacerbated chronic colitis leading to increased colitis-associated colorectal tumorigenesis. Supplemental psyllium fiber attenuated these procarcinogenic effects of a HFrD. Citation Format: Srijani Basu, Ryohei Nishiguchi, David C. Montrose, Hannah Staab, Xi Kathy Zhou, Hanhan Wang, Melanie Johncilla, Rhonda K. Yantiss, Andrew Dannenberg. Psyllium protects against high fructose diet induced exacerbation of colitis and colitis associated colorectal carcinogenesis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3461.

Development and clinical evaluation of a 3-step modified manipulation protocol for MRI-guided high-intensity focused ultrasound of uterine fibroids

The clinical applicability of magnetic resonance image-guided high-intensity focused ultrasound (MR-HIFU) treatment of uterine fibroids is often limited due to inaccessible fibroids or bowel interference. The aim of this study was to implement a newly developed 3-step modified manipulation protocol and to evaluate its influence on the number of eligible women and treatment failure rate. From June 2016 to June 2018, 165 women underwent a screening MRI examination, 67 women of whom were consecutively treated with MR-HIFU at our institution. Group 1 (n = 20) was treated with the BRB manipulation protocol which consisted of sequential applications of urinary bladder filling, rectal filling, and urinary bladder emptying. Group 2 (n = 47) was treated using the 3-step modified manipulation protocol which included (1) the BRB maneuver with adjusted rectal filling by adding psyllium fibers to the solution; (2) Trendelenburg position combined with bowel massage; (3) the manual uterine manipulation (MUM) method for uterine repositioning. A comparison was made between the two manipulation protocols to evaluate differences in safety, the eligibility percentage, and treatment failure rate due to unsuccessful manipulation. After implementing the 3-step modified manipulation protocol, our ineligibility rate due to bowel interference or inaccessible fibroids decreased from 18% (16/88) to 0% (0/77). Our treatment failure rate due to unsuccessful manipulation decreased from 20% (4/20) to 2% (1/47). There were no thermal complications to the bowel or uterus. Implementation of the 3-step modified manipulation protocol during MR-HIFU therapy of uterine fibroids improved the eligibility percentage and reduced the treatment failure rate. Registry number NL56182.075.16 KEY POINTS: • A newly developed 3-step modified manipulation protocol was successfully implemented without the occurrence of thermal complication to the bowel or uterus. • The 3-step modified manipulation protocol increased our eligibility percentage for MR-HIFU treatment of uterine fibroids. • The 3-step modified manipulation protocol reduced our treatment failure rate for MR-HIFU treatment of uterine fibroids.