The aim of this study was to investigate factors contributing to poor bowel preparation in patients undergoing colonoscopy procedures. We used a reproducible search strategy to identify studies, ...searching 10 medical databases, including PubMed, Ovid, Medline, and Cochrane Library Database for reports published between 2000 and 2016. Fully published studies, evaluating risk factors for inadequate bowel preparation, were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. Pooling was conducted with both fixed-effects and random-effects models; results were presented from the random effects model when heterogeneity was significant. Odds ratios (OR) estimates with 95% confidence interval were calculated. Heterogeneity was assessed by I statistics. Twenty-four studies with a total of 49 868 patients met the inclusion criteria. Age (OR−1.20), male sex (OR0.85), inpatient status (OR0.57), diabetes mellitus (OR0.58), hypertension (OR0.58), cirrhosis (OR0.49), narcotic use (OR0.59), constipation (OR0.61), stroke (OR; 0.51), and tricyclic antidepressant (TCA) use (0.51), were associated with inadequate bowel preparation. In our sensitivity analysis comparing Western and Asian countries, we found that diabetes, cirrhosis, male sex, history of stroke and TCA use were stronger risk factors for inadequate bowel preparation in Western countries than in Asian countries. We also found that history of stroke, TCA use, and race were risk factors for inadequate bowel preparation in patients receiving conventional bowel preparation compared with those receiving split-dose bowel preparation. Multiple risk factors affect the quality of bowel preparation and specific risk factors can be intervened upon, in different populations, to optimize preparation.
Cirrhosis results from progressive fibrosis and is the final outcome of all chronic liver disease.It is among the ten leading causes of death in United States.Cirrhosis can result in portal ...hypertension and/or hepatic dysfunction.Both of these either alone or in combination can lead to many complications,including ascites,varices,hepatic encephalopathy,hepatocellular carcinoma,hepatopulmonary syndrome,and coagulation disorders.Cirrhosis and its complications not only impair quality of life but also decrease survival.Managing patients with cirrhosis can be a challenge and requires an organized and systematic approach.Increasing physicians’knowledge about prevention and treatment of these potential complications is important to improve patient outcomes.A literature search of the published data was performed to provide a comprehensive review regarding the management of cirrhosis and its complications.
Poor sleep quality is associated with adverse health consequences. Sleep disturbances can impact the immune function and process of inflammation. The relationship between sleep quality and the ...inflammatory bowel disease (IBD) has not been well studied.
A prospective observational cohort study was performed to assess the correlation of the quality of sleep and disease activity in IBD. We used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality. IBD disease activity was measured by using the Harvey-Bradshaw Index or Modified Mayo Score.
Forty-one patients were enrolled with mean age of 37 ± 15.4 years and 27 (66%) women. Abnormal PSQI was present in all 23 (100%) of the clinically active patients and in 13 (72%) of those with inactive disease (odds ratio = 2.8, P = 0.007). All 30 patients with histologic evidence of inflammation on recent ileocolonoscopy also had abnormal PSQI scores, which were independent of their clinical disease activity status. Only 6 of 11 patients with histologically quiescent disease had abnormal PSQI scores (odds ratio = 6.0, P < 0.0001). There was no difference in disease type, use of steroids, the presence of depression or anxiety, and body mass index between the patients with normal and abnormal sleep. An abnormal PSQI had a positive predictive value for histologic inflammatory activity of 83%.
Our data show a strong association between clinically active IBD and poor sleep quality and demonstrate that patients in clinical remission with abnormal sleep have a high likelihood of subclinical disease activity.
Background
Insufflation of the colon allows for adequate visualization of the mucosal tissue and advancement of the endoscope during colonoscopy. Most colonoscopies are performed with sedation to ...mitigate discomfort and enhance the colonoscopy experience for both the patient and the endoscopist.
Aim
We aimed to evaluate factors associated with difficulty maintaining insufflation.
Methods
A cross-sectional study of individuals undergoing colonoscopy at the Oklahoma City Veterans Affairs Medical Center was performed. Experiencing difficulty maintaining air insufflation during colonoscopy was assessed with a questionnaire completed by the performing endoscopist at the end of procedure. Information regarding procedure times, sedation used, demographics, comorbidities, surgical history, and medications used was extracted from the medical record. A multivariate regression analysis was performed to identify factors associated with difficulty maintaining air insufflation. A
P
value < 0.05 was considered significant.
Results
996 Patients were included for the analysis. Difficulty with insufflation was reported in 240 (24%) colonoscopies; mean age of 63.8 ± 10.4 years old and 13% were female. Fellow trainees were involved in 669 (67%) colonoscopies. Older age (OR 1.02,
P
0.03, CI 1.00–1.04), diabetes (OR 1.5, 95% CI 1.03, 2.05), fellow’s involvement (OR 2.6. (95% CI 1.68, 4.09), total procedure time (OR 1.02, 95% CI 1.00, 1.03), mean number of adenomas (OR 1.05, 95% CI 1.00, 1.09), and MAC use (OR 2.6, 95% CI 1.80, 3.85) were independent predictors for difficulty in maintaining air insufflation.
Conclusion
Our findings suggest that endoscopists should be cognizant of colon insufflation issues in older, diabetic patients undergoing colonoscopies under deep sedation, particularly if prolonged procedure is anticipated or encountered.
Background The adenoma detection rate (ADR) is a quality benchmark for colonoscopy, influenced by several factors including bowel preparation, withdrawal time, and withdrawal technique. Objective To ...assess the impact of video recording of all colonoscopies on the ADR. Design Comparison of two cohorts of patients undergoing colonoscopy before and after implementation of video recording. Setting Academic outpatient endoscopy facility. Patients This study involved asymptomatic, average-risk adults undergoing screening colonoscopy. Intervention Video recording of all colonoscopy procedures. Polyp findings and withdrawal times were recorded for 208 consecutive screening colonoscopies. A policy of video recording all colonoscopies was implemented and announced to the staff. Data on another 213 screening colonoscopies were subsequently collected. Main Outcome Measurements Adenoma detection rate, withdrawal time, advanced polyp detection rate, hyperplastic polyp detection rate. Results At least one adenoma was found in 38.5% of patients after video recording versus 33.7% before video recording ( P = .31). There was a significant increase in the hyperplastic polyp detection rate (44.1% vs 34.6%; P = .046). Most endoscopists had a numerical increase in their ADRs, but only one was significant (57.7% vs 22.6%; P < .01). There were trends toward higher detection of adenomas of <5 mm (59.1% vs 52%; P = .23) and right-sided adenomas (40.2% vs 30.4%; P = .11) in the video recorded group. Limitations No randomization, confounding of intervention effects, and sample size limitations. Conclusion Video recording of colonoscopies is associated with a nonsignificant increase in the ADR and a significant increase in the hyperplastic polyp detection rate. There may be a benefit of video recording for endoscopists with low ADRs.
To determine the rate of use and non-use of prophylactic percutaneous endoscopic gastrostomy (PEG) tubes among patients with head and neck cancer (HNC) patients.
All patients with HNC undergoing PEG ...between January 1, 2004 and June 30, 2006 were identified. Patients (or their next-of-kin) were surveyed by phone and all available medical records and cancer registry data were reviewed. Prophylactic PEG was defined as placement in the absence of dysphagia and prior to radiation or chemoradiation. Each patient with a prophylactic PEG was assessed for cancer diagnosis, type of therapy, PEG use, and complications related to PEG.
One hundred and three patients had PEG tubes placed for HNC. Thirty four patients (33%) could not be contacted for follow-up. Of the 23 (22.3%) patients with prophylactic PEG tubes, 11/23 (47.8%) either never used the PEG or used it for less than 2 wk. No association with PEG use vs non-use was observed for cancer diagnosis, stage, or specific cancer treatment. Non-use or limited use was observed in 3/6 (50%) treated with radiation alone vs 8/17 (47.1%) treated with chemoradiation (P = 1.0), and 3 of 10 (30%) treated with surgery vs 8 of 13 (62%) not treated with surgery (P = 0.21). Minor complications were reported in 5/23 (21.7%). One (4.3%) major complication was reported.
There is a high rate of unnecessary PEG placement when done prophylactically in patients with head and neck cancer.
Background
Intestinal electrical stimulation (IES) has been proposed as a potential treatment for obesity. The aim of this study was to explore the central mechanism underlying the reduction of food ...intake and body weight by IES by studying the expression of anorexigenic- and orexigenic-peptide-containing neurons in the hypothalamus.
Materials and Methods
Diet-induced obese (DIO) rats were divided into three groups to receive sham, IES, and pair-feeding for 4 weeks. Food intake was measured automatically and presented as daily and body weight measured weekly. The expressions of oxytocin, an anorexigenic neuropeptide, in the paraventricular nucleus of the hypothalamus (PVN) and the supraoptic nuclei of the hypothalamus (SON) and orexin-A, an orexigenic neuropeptide, in the lateral hypothalamic area (LHA) were studied using immunohistochemistry.
Results
Compared with sham, IES reduced daily food intake by 28.3% at week 1, 35.6% at week 2, 15.6% at week 3, and 27.1% at week 4. Consistently, IES reduced body weight by 6.3%, compared with a weight gain of 7.2% in sham, and a slight weight loss of 0.5% in pair-feeding. Compared with sham, IES increased the expression of oxytocin-immunoreactive neurons in PVN and SON. Compared with sham, IES decreased the expression of orexin-immunoreactive neurons in LHA. Rats with pair-feeding also showed a relative decease in weight without any changes in the central hormones.
Conclusion
IES reduces food intake and body weight and improves glucose tolerance and insulin sensitivity in DIO rats. Its central mechanisms involve enhancement of anorexigenic peptides and suppression of orexigenic peptides in the hypothalamus.
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