Abstract
Background
Bowel preparation is the most burdensome part of the whole colonoscopy procedure according to patients. A diagnosis of Inflammatory Bowel Disease (IBD) implies the need for ...lifelong repeated colonoscopies, therefore amplifying the problem. Bowel preparation with oral Mannitol, a sugar alcohol with a sweet taste, could significantly improve the patients’ tolerance as it has a quick onset, is single dose and has a low volume.1-3
Methods
This is a post-hoc analysis of IBD patients included in the SATISFACTION study, a third phase multicentre, international, randomized, endoscopists-blinded controlled trial4. Patients were randomized (1:1) to 750mL of oral mannitol (OM, 100 g in 750 mL water) to be drunk in a single dose 4 hours before colonoscopy versus a standard split preparation with 2L PEG-ASC (PEG). An intention to treat analysis was performed on patients who underwent colonoscopy and who took bowel preparation even partially. Biological important parameters summarising the rate of bowel cleansing and patients’ satisfaction were collected.
Results
A total of 55 IBD patients (M = 24, P = 31, Crohn’s = 12, Ulcerative Colitis = 40, Microscopic colitis =3) from 7 centres were ruled in for this post-hoc analysis. The two population were comparable in terms of age and sex and diseases (Table 1). A statistically significant preference of OMl over PEG was found in terms of taste (numerical rating scale – NRS, p < 0.001), willingness to reuse the preparation (p = 0.03), and of time of first evacuation (M 56.6 minutes, P 90.7, p = 0.01). No differences were found in terms of adequate bowel cleansing as assessed by the Boston bowel preparation scale (96% OM, 97% PEG), adherence to bowel preparation (complete in 100% OM, 94% PEG) and easy of use (88% OM, 71% PEG). Minor and expected adverse events of special interest such as nausea and abdominal pain were comparable in the two courts (12% OM, 3% PEG).
Conclusion
Bowel preparation with a very low volume of oral mannitol in a single dose 4 h before colonoscopy provides better satisfaction among IBD patients and showed an excellent efficacy and safety profile as compared to the standard split preparation with 2L PEG-ASC. Same day bowel preparation with oral mannitol is a reliable option for colonoscopy in IBD and an effective strategy to improve the patients’ acceptance.
Funding/Acknowledgment
The Satisfaction study was funded by NTC, Milan, Italy.
References
1. Spada C et al. Eur J Clin Pharmacol. 2022 Dec;78(12):1991-2002.
2. Fiori G et al. Clin Transl Sci. 2022 Oct;15(10):2448-2457.
3. Carnovali M et al. Clin Transl Sci. 2023 May;16(5):759-769.
4. Tontini G.E. et al. Endoscopy 2023; 55; s64
In this work, a modified version of the FSF (Filtered Surface Force) method is presented. The method was originally developed by Raeini et al. specifically for modeling low Capillary number ...multiphase flows, basing its structure on a well consolidated VoF (Volume of Fluid) CSF (Continuum Surface Force) solver in OpenFOAM®. The numerical method proposed in this paper is a combination of the FSF and the CICSAM scheme of Ubbink, which has been translated into a TVD framework instead of its original NVD formulation. The capability of this scheme in compressing the interface numerically lets to simplify the FSF formulation, avoiding the modification of the indicator function for the computation of the surface tension forces. Moreover, a different formulation of the filter applied to the capillary forces is presented as a simplification of the original implementation. The time step is limited by capillary forces time scale and the Courant number is chosen as a compromise between the necessity of reducing the calculation time and the numerical diffusion of the advection schemes. The methodology is validated with several test cases, showing different problems of the classical CSF method and making comparisons with theoretical solutions.
•TVD implementation of CICSAM scheme for interface capturing method in OpenFOAM.•The FSF approach is combined with the CICSAM scheme to avoid Level-Set function.•The modified FSF method is able to suppress the spurious currents.•The method can handle the transportation of the interface in non-oriented mesh.
Background
Colonoscopy is a widely used diagnostic and therapeutic modality. A large proportion of the population is likely to undergo colonoscopy for diagnosis and treatment of colorectal diseases, ...or when participating in colorectal cancer screening programs. To reduce pain, water infusion instead of traditional air insufflation during the insertion phase of the colonoscopy has been proposed, thereby improving patients’ acceptance of the procedure. Moreover, the water infusion method may improve early detection of precancerous neoplasms.
Objectives
To compare water infusion techniques with standard air insufflation, specifically evaluating technical quality and screening efficacy, as well as patients’ acceptance of the water infusion procedure.
Search methods
We searched the Cochrane Colorectal Cancer Group Specialized Register (February 2014), the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1), Ovid MEDLINE (1950 to February 2014), Ovid EMBASE (1974 to February 2014), and ClinicalTrials.gov (1999 to February 2014) for eligible randomised controlled trials.
Selection criteria
We included randomised controlled trials comparing water infusion (water exchange or water immersion methods) against standard air insufflation during the insertion phase of the colonoscopy.
Data collection and analysis
Two review authors independently assessed the studies for inclusion and extracted data from eligible studies. We performed analysis using Review Manager software (RevMan 5).
Main results
We included 16 randomised controlled trials consisting of 2933 colonoscopies. Primary outcome measures were cecal intubation rate and adenoma detection; secondary outcomes were time needed to reach the cecum, pain experienced by participants during the procedure, completion of cecal intubation without sedation/analgesia, and adverse events. Completeness of colonoscopy, that is cecal intubation rate, was similar between water infusion and standard air insufflation (risk ratio 1.00, 95% confidence interval (CI) 0.97 to 1.03, P = 0.93). Adenoma detection rate, that is number of participants with at least one detected adenoma, was slightly improved with water infusion (risk ratio 1.16, 95% CI 1.04 to 1.30, P = 0.007). Assuming the fraction of patients undergoing screening colonoscopy who had one or more adenomas detected was 20 per 100 with standard colonoscopy, the use of water colonoscopy may increase the fraction to 23 per 100 individuals. From our findings, it is possible that up to 68,000 more of the 1.7 million outpatient screening colonoscopies performed annually in the United States, could detect adenomas if water infusion colonoscopy was used. In addition, with water infusion participants experienced significantly less pain (mean difference in pain score on a 0 to 10 scale: ‐1.57, 95% CI ‐2.00 to ‐1.14, P < 0.00001) and a significantly lower proportion of participants requested on‐demand sedation or analgesia, or both (risk ratio 1.20, 95% CI 1.14 to 1.27, P < 0.00001). Qualitative analysis suggests that water infusion colonoscopy was not associated with a markedly increased rate of adverse events compared with the standard procedure.
Authors' conclusions
Completeness of colonoscopy, that is cecal intubation rate, was not improved by water infusion compared with standard air insufflation colonoscopy. However, adenoma detection, assessed with two different measures (that is adenoma detection rate and number of detected adenomas per procedure), was slightly augmented by the water infusion colonoscopy. Improved adenoma detection might be due to the cleansing effects of water infusions on the mucosa. Detection of premalignant lesions during standard colonoscopy is suboptimal, and so improvements in adenoma detection by water infusion colonoscopy, although small, may help to reduce the risk of interval colorectal carcinoma. The most obvious benefit of water infusion colonoscopy was reduction of procedure‐related abdominal pain, which may enhance the acceptance of screening/surveillance colonoscopy.
Background: The safety and tolerance of routine sedation and analgesia versus “on demand” sedation were compared in patients undergoing colonoscopy.
Methods: Two hundred forty-nine outpatients were ...randomly assigned to one of two groups. Group A (n = 125) received midazolam, 0.07 mg/kg intravenously plus meperidine, 0.77 mg/kg intravenously immediately preceding the colonoscope insertion. Group B (n = 124) received the same medication upon request during the procedure. Tolerance was assessed 24 hours later by phone interview performed by a nurse blinded to the medication regimen administered.
Results: Eighty-three patients (66%) in Group B required sedation during colonoscopy. Among men in Group B more than 60 years of age, only 23% required sedation. The proportion of patients reporting moderate or severe pain (34% vs. 12.1%,
p < 0.001) and of those stating they would not be willing to undergo colonoscopy again in the future (22% vs. 9.7%,
p < 0.005) was significantly higher in the “on demand” sedation group. By multivariate analysis the randomization group was the single variable independently associated with both such outcomes. The frequency of side effects was similar in the two groups.
Conclusions: Administration of sedative and analgesic drugs routinely before colonoscopy is superior to “on demand” sedation in terms of tolerance and is not associated with an increase in side effects. (Gastrointest Endosc 2001;54:169-74.)
Schizotetranychus oryzae
Rossi de Simons (Acari: Tetranychidae) is considered one of the most important phytophagous mite in rice cultivation in the Americas South, Central, and North. This study ...aimed to examine some biological aspects of
S. oryzae
developing on leaves of three different cultivars of rice
Oryza sativa
(L.)—Poaceae produced in the state of Rio Grande do Sul, Brasil. The plants were kept in a room at 25 ± 1°C, with natural light (photophase of approximately 14 h) and 70 ± 5% relative humidity. During the immature stages, observations were carried out daily at 7 am, 1 pm, and 7 pm. The results showed that the mean duration of the egg–adult period in days were similar between cultivars evaluated (Irga 424, 11.27 ± 0.13; Taim, 11.21 ± 0.14 and Sinuelo, 11.13 ± 0.15). Egg–adult viability on Irga 424, Sinuelo, and Taim was 61.9, 85.71, and 90.48%, respectively, being lowest on Irga 424 (
χ
2 = 28.62,
p
< 0.0001). The duration of the immature stages was not affected by cultivar, but on Irga 424, egg–adult viability and female longevity were lower. The results of this study can help select
O. sativa
cultivar resistant to
S. oryzae
. However, historically, the IRGA 424 has lower populations of
S. oryzae
in field conditions.
