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Zorbas KA, Yu D, Choudhry A, Ross HM, Philp M. Preoperative bowel preparation does not favor the management of colorectal anastomotic leak. World J Gastrointest Surg 2019; 11:218-228. [PMID: 31123559 PMCID: PMC6513788 DOI: 10.4240/wjgs.v11.i4.218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/23/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Controversy exists regarding the impact of preoperative bowel preparation on patients undergoing colorectal surgery. This is due to previous research studies, which fail to demonstrate protective effects of mechanical bowel preparation against postoperative complications. However, in recent studies, combination therapy with oral antibiotics (OAB) and mechanical bowel preparation seems to be beneficial for patients undergoing an elective colorectal operation.
AIM To determine the association between preoperative bowel preparation and postoperative anastomotic leak management (surgical vs non-surgical).
METHODS Patients with anastomotic leak after colorectal surgery were identified from the 2013 and 2014 Colectomy Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and were employed for analysis. Every patient was assigned to one of three following groups based on the type of preoperative bowel preparation: first group-mechanical bowel preparation in combination with OAB, second group-mechanical bowel preparation alone, and third group-no preparation.
RESULTS A total of 652 patients had anastomotic leak after a colectomy from January 1, 2013 through December 31, 2014. Baseline characteristics were assessed and found that there were no statistically significant differences between the three groups in terms of age, gender, American Society of Anesthesiologists score, and other preoperative characteristics. A χ2 test of homogeneity was conducted and there was no statistically/clinically significant difference between the three categories of bowel preparation in terms of reoperation.
CONCLUSION The implementation of mechanical bowel preparation and antibiotic use in patients who are going to undergo a colon resection does not influence the treatment of any possible anastomotic leakage.
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Affiliation(s)
- Konstantinos A Zorbas
- Department of Surgery, BronxCare Health System, NY 10457, United States
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
| | - Daohai Yu
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, PA 19140, United States
| | - Aruj Choudhry
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
| | - Howard M Ross
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
| | - Matthew Philp
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
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Preoperative bowel preparation for patients undergoing elective colorectal surgery: a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons. Burns 2010; 36:1320-1; author reply 1318-20. [PMID: 21092431 DOI: 10.1016/j.burns.2010.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 03/03/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite evidence that mechanical bowel preparation (MBP) does not reduce the rate of postoperative complications, many surgeons still use MBP before surgery. We sought to appraise and synthesize the available evidence regarding preoperative bowel preparation in patients undergoing elective colorectal surgery. METHODS We searched MEDLINE, EMBASE and Cochrane Databases to identify randomized controlled trials (RCTs) comparing patients who received a bowel preparation with those who did not. Two authors reviewed the abstracts to identify articles for critical appraisal. We used the methods of the United States Preventive Services Task Force to grade study quality and level of evidence, as well as formulate the final recommendations. Outcomes assessed included postoperative infectious complications, such as anastomotic dehiscence and superficial surgical site infections. RESULTS Our review identified 14 RCTs and 8 meta-analyses. Based on the quality and content of these original manuscripts, we formulated 6 recommendations for various aspects of bowel preparation in patients undergoing elective colorectal surgery. CONCLUSION Taking into account the lack of difference in postoperative infectious complication rates when MBP is omitted and the adverse effects of MBP, we believe that, based on the literature, MBP before surgery should be omitted.
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Syndrome of inappropriate secretion of antidiuretic hormone after endoscopic submucosal dissection for early gastric cancer. Clin J Gastroenterol 2009; 2:262-265. [PMID: 26192421 DOI: 10.1007/s12328-009-0085-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
Abstract
We report the first case of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after endoscopic submucosal dissection (ESD) for early gastric cancer. A 64-year-old man with early gastric cancer was admitted to our hospital for ESD. Baseline laboratory tests showed a serum sodium concentration of 132 mEq l(-1). We performed an ESD for the gastric cancer, which was 9 mm in diameter and located in the posterior wall of the mid-gastric body. The patient experienced nausea and lethargy the second day after ESD. His serum sodium level was low (118 mEq l(-1)), and he fulfilled the criteria for SIADH. Fluid restriction, infusion of normal saline, and administration of diuretics gradually increased his serum sodium level, and his symptoms disappeared. Endoscopists should recognize that SIADH is a potential complication of endoscopic procedures such as ESD, especially among patients with low baseline sodium concentrations.
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Abstract
The success and accuracy of colonoscopy is largely dependent on appropriate cleansing of the colon. The ideal bowel preparation should be safe, well-tolerated and effective. Although colonoscopy preparations are vastly better than the earliest barium enemas used in X-ray regimens, none of the currently available formulations sufficiently fulfills the above criteria. Currently used techniques of colon cleansing include dietary and cathartic methods, gut lavage and the administration of phosphates. All of these methods are efficacious, particularly when administered in a split dose (one the evening before and one just before the planned colonoscopy). Gut lavage methods are the safest method; however, dietary and cathartic methods are also reasonably safe. Low-dose phosphate preparations are well tolerated, but safety concerns have led to the withdrawal of some phosphate products from the US market. A new oral sulfate product that achieves a desirable balance of safety, tolerability in patients and efficacy will shortly be introduced. Physicians should be aware of the range of colonoscopy preparations available and their limitations, so that the best preparation can be chosen for an individual patient.
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Belsey J, Epstein O, Heresbach D. Systematic review: adverse event reports for oral sodium phosphate and polyethylene glycol. Aliment Pharmacol Ther 2009; 29:15-28. [PMID: 18729847 DOI: 10.1111/j.1365-2036.2008.03837.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Screening colonoscopy exposes healthy patients to the risk of serious adverse events associated with bowel preparation. Randomized controlled trials are not an effective method for evaluating this risk. AIM To search published literature in order to characterize the risk of adverse events associated with oral polyethylene glycol (PEG) or sodium phosphate (NaP). METHODS A systematic review identified case reports of any serious events associated with PEG or NaP. Reports to the Food and Drug Administration (FDA) were also examined. RESULTS Fifty-eight publications of significant events in 109 patients using NaP and 22 patients using PEG were identified. As the total number of prescriptions issued is unknown, rates for the two agents cannot be directly compared. Most commonly reported were electrolyte disturbances, renal failure and colonic ulceration for NaP and Mallory-Weiss tear, electrolyte disturbances and allergic reactions for PEG between January 2006 and December 2007; there were 171 cases of renal failure reported to the FDA following use of NaP and 10 following PEG. CONCLUSIONS Adverse events following bowel preparation are uncommon, but potentially serious. Given that many of these patients are healthy individuals undergoing screening, the benefit/risk ratio must be carefully considered when deciding which preparation to prescribe in individual patients.
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Affiliation(s)
- J Belsey
- JB Medical Ltd, The Old Brickworks, Sudbury, UK.
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Lichtenstein GR, Cohen LB, Uribarri J. Review article: Bowel preparation for colonoscopy--the importance of adequate hydration. Aliment Pharmacol Ther 2007; 26:633-41. [PMID: 17697197 DOI: 10.1111/j.1365-2036.2007.03406.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patient compliance with screening recommendations for colorectal cancer remains low, despite a 90% survival rate achieved with early detection. Bowel preparation is a major deterrent for patients undergoing screening colonoscopy. More than half of patients taking polyethylene glycol electrolyte lavage solution and sodium phosphate preparations experience adverse events, such as nausea and abdominal pain. Many adverse events may be associated with dehydration, including rare reports of renal toxicity in patients taking sodium phosphate products. Addressing dehydration-related safety issues through patient screening and education may improve acceptance of bowel preparations, promote compliance and increase the likelihood of a successful procedure. AIM To evidence safety issues associated with bowel preparation are generally related to inadequate hydration. RESULTS Dehydration-related complications may be avoided through proper patient screening, for example, renal function and comorbid conditions should be considered when choosing an appropriate bowel preparation. In addition, patient education regarding the importance of maintaining adequate hydration before, during and after bowel preparation may promote compliance with fluid volume recommendations and reduce the risk of dehydration-related adverse events. CONCLUSIONS Proper patient screening and rigorous attention by patients and healthcare providers to hydration during bowel preparation may provide a safer, more effective screening colonoscopy.
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Affiliation(s)
- G R Lichtenstein
- Hospital of the University of Pennsylvania, Gastroenterology Division, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4283, USA.
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Nagler J, Poppers D, Turetz M. Severe hyponatremia and seizure following a polyethylene glycol-based bowel preparation for colonoscopy. J Clin Gastroenterol 2006; 40:558-9. [PMID: 16825941 DOI: 10.1097/00004836-200607000-00017] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rose M, Karlstadt RG, Walker K. Renal failure following bowel cleansing with a sodium phosphate purgative. Nephrol Dial Transplant 2005; 20:1518-9. [PMID: 15919692 DOI: 10.1093/ndt/gfh908] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Adequate colonic cleansing is essential for accurate and safe colonic procedures. Common preparations for cleansing include diet in combination with a cathartic agent, gut lavage, and phosphate preparations. The diet used with a cathartic consists of clear liquids or is designed to leave a minimal colonic fecal residue with laxatives. Gut lavage solutions wash out the colon in a safe and effective manner. Phosphate preparations offer an attractive alternative due to smaller volumes required for ingestion; however, electrolyte disturbances can occur. This review discusses the development and clinical experience with various colon cleansing regimens and efforts to improve the tolerability and safety of preparation for colonoscopy, virtual colonoscopy, colon surgery, barium enema, and flexible sigmoidoscopy.
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Affiliation(s)
- Andrew R Brown
- Department of Medicine, Division of Gastroenterology, University of South Alabama, Knollwood Pavillion, 5600 Girby Road, Mobile, AL 36693, USA
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Abstract
Oral sodium phosphate and sodium picosulfates/magnesium citrate are commonly used to evacuate the colon and rectum before colonoscopy or colorectal surgery. These substances, however, are known to cause electrolyte abnormalities. Seizures caused by electrolyte abnormalities associated with bowel preparation have only rarely been reported. We report the cases of three patients with no prior history of seizures, who had their first seizure associated with hyponatremia following ingestion of sodium phosphate or sodium picosulfates/magnesium citrate combination. Care must be taken with patients with a low seizure threshold and those with possible chronic sodium depletion, such as patients on thiazide diuretics, who are undertaking bowel preparation with oral sodium phosphate or sodium picosulfates/magnesium citrate combination.
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Affiliation(s)
- F A Frizelle
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
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Abstract
There are various methods available to cleanse the colon in preparation for diagnostic and surgical procedures. The popular options are diet and cathartic regimens, gut lavage and phosphate preparations. Each method has its own unique characteristics and safety profile. Diet and cathartic regimens are based on traditional methods of colonoscopy preparation and remain an acceptable and safe alternative for patients unwilling or unable to tolerate other bowel preparations. Gut lavage methods involve ingestion of 2-4L of osmotically balanced solutions containing polyethylene glycol, which have been shown to be safe and effective for colon cleansing, including for special patient populations with cardiac, renal or hepatic dysfunction. Phosphate preparations have also been shown to be safe and effective for colon cleansing and are generally better tolerated than counterpart gut lavage solutions. However, this method has safety concerns for some patients with cardiac, renal and hepatic dysfunctions.
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Affiliation(s)
- Larry E Clark
- Division of Gastroenterology, University of South Alabama College of Medicine, Mobile, Alabama 36693, USA
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Balaban DH, Leavell BS, Oblinger MJ, Thompson WO, Bolton ND, Pambianco DJ. Low volume bowel preparation for colonoscopy: randomized, endoscopist-blinded trial of liquid sodium phosphate versus tablet sodium phosphate. Am J Gastroenterol 2003; 98:827-32. [PMID: 12738463 DOI: 10.1111/j.1572-0241.2003.07380.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to compare the colon-cleansing effectiveness, ease of consumption, and side effect profiles of two commercially available preparations of sodium phosphate: liquid Fleet Phospho-soda and Visicol tablets. METHODS Outpatients undergoing elective colonoscopy were sequentially randomized to one of two preparation groups: liquid: 45 ml at 7:00 PM, 45 ml 3 h before colonoscopy; or tablet: 20 tablets at 7:00 PM, 20 tablets 3-5 h before colonoscopy. Subjects rated preparation tolerability on a 5-point Likert scale. A Residual Stool Score was calculated for each subject based on the amount of stool, consistency of residual stool, and percent of bowel visualized (range 0-11, 0 = best). The endoscopists were blinded to the preparation used. RESULTS A total of 101 subjects were enrolled (43 male, 58 female, mean age 58.2 yr). The groups were similar in age and indications for colonoscopy. Overall, bowel cleansing was rated "Excellent" or "Good" in 92% of liquid preparation subjects, compared with 74% of tablet preparation subjects (p = 0.03). Subjects in the liquid group demonstrated significantly less residual stool than did tablet subjects (Residual Stool Scores: liquid 1.3 +/- 1.2 vs tablet 1.9 +/- 1.5, p < 0.05). Subjects rated the liquid preparation easier to swallow (p < 0.005) and more convenient to take (p < 0.005) than tablets. Among liquid subjects, 45 of 50 reported a willingness to take their preparation for future colonoscopies, compared with 36 of 49 who took tablet sodium phosphate (p < 0.04). CONCLUSIONS Liquid sodium phosphate is better tolerated and more effective at colon cleansing when compared with sodium phosphate in tablet form.
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Affiliation(s)
- David H Balaban
- Charlottesville Gastroenterology Associates, Charlottesville, Virginia 22902, USA
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:727-42. [PMID: 12512251 DOI: 10.1002/pds.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Shuster J. Toxic Epidermal Necrolysis with Levofloxacin; Serotonin Syndrome Associated with Linezolid; Severe Hypokalemia Seen with Dicloxacillin Therapy; Terfinabine Hepatotoxicity. Hosp Pharm 2002. [DOI: 10.1177/001857870203700911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
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Affiliation(s)
- Joel Shuster
- Temple University School of Pharmacy, Philadelphia
- Medical College of Pennsylvania Hospital, Philadelphia
- Institute for Safe Medication Practices, Huntingdon Valley, PA 19006
- ISMP, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006
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