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Konikoff T, Flugelman A, Comanesther D, Cohen AD, Gingold-Belfer R, Boltin D, Golan MA, Eizenstein S, Dotan I, Perry H, Levi Z. The use of artificial intelligence to identify subjects with a positive FOBT predicted to be non-compliant with both colonoscopy and harbor cancer. Dig Liver Dis 2023; 55:1253-1258. [PMID: 37286451 DOI: 10.1016/j.dld.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Subjects with a positive Fecal Occult Blood Test (FOBT) that are non-compliant with colonoscopy are at increased risk for colorectal cancer (CRC). Yet, in clinical practice, many remain non-compliant. AIMS To evaluate whether machine learning models (ML) can identify subjects with a positive FOBT predicted to be both non-compliant with colonoscopy within six months and harbor CRC (defined as the "target population"). METHODS We trained and validated ML models based on extensive administrative and laboratory data about subjects with a positive FOBT between 2011 and 2013 within Clalit Health that were followed for cancer diagnosis up to 2018. RESULTS Out of 25,219 included subjects, 9,979(39.6%) were non-compliant with colonoscopy, and 202(0.8%) were both non-compliant and harbored cancer. Using ML, we reduced the number of subjects needed to engage from 25,219 to either 971 (3.85%) to identify 25.8%(52/202) of the target population, reducing the number needed to treat (NNT) from 124.8 to 19.4 or to 4,010(15,8%) to identify 55.0%(52/202) of the target population, NNT = 39.7. CONCLUSION Machine learning technology may help healthcare organizations to identify subjects with a positive FOBT predicted to be both non-compliant with colonoscopy and harbor cancer from the first day of a positive FOBT with improved efficiency.
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Affiliation(s)
- Tom Konikoff
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Anath Flugelman
- Technion Israel Institute of Technology The Ruth and Bruce Rappaport Faculty of Medicine Haifa, Haifa, Israel
| | - Doron Comanesther
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel
| | - Arnon Dov Cohen
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rachel Gingold-Belfer
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | | | | | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Hagit Perry
- Department of Information Systems, Arison School of Business, Interdisciplinary Center, Herzliya, Israel
| | - Zohar Levi
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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D’Angelo V, Piccirillo MC, Di Maio M, Gallo C, Bucci C, Civiletti C, Di Girolamo E, Marone P, Rossi GB, Tempesta AM, Tracey MC, Romano M, Miranda A, Taranto D, Sessa G, Esposito P, Salerno R, Pumpo R, De Filippo FR, Della Valle E, de Bellis M, Perrone F. A multicenter randomized phase 4 trial comparing sodium picosulphate plus magnesium citrate vs. polyethylene glycol plus ascorbic acid for bowel preparation before colonoscopy. The PRECOL trial. Front Med (Lausanne) 2022; 9:1013804. [PMID: 36569131 PMCID: PMC9773881 DOI: 10.3389/fmed.2022.1013804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022] Open
Abstract
Background Adequate bowel preparation before colonoscopy is crucial. Unfortunately, 25% of colonoscopies have inadequate bowel cleansing. From a patient perspective, bowel preparation is the main obstacle to colonoscopy. Several low-volume bowel preparations have been formulated to provide more tolerable purgative solutions without loss of efficacy. Objectives Investigate efficacy, safety, and tolerability of Sodium Picosulphate plus Magnesium Citrate (SPMC) vs. Polyethylene Glycol plus Ascorbic Acid (PEG-ASC) solutions in patients undergoing diagnostic colonoscopy. Materials and methods In this phase 4, randomized, multicenter, two-arm trial, adult outpatients received either SPMC or PEG-ASC for bowel preparation before colonoscopy. The primary aims were quality of bowel cleansing (primary endpoint scored according to Boston Bowel Preparation Scale) and patient acceptance (measured with six visual analogue scales). The study was open for treatment assignment and blinded for primary endpoint assessment. This was done independently with videotaped colonoscopies reviewed by two endoscopists unaware of study arms. A sample size of 525 patients was calculated to recognize a difference of 10% in the proportion of successes between the arms with a two-sided alpha error of 0.05 and 90% statistical power. Results Overall 550 subjects (279 assigned to PEG-ASC and 271 assigned to SPMC) represented the analysis population. There was no statistically significant difference in success rate according to BBPS: 94.4% with PEG-ASC and 95.7% with SPMC (P = 0.49). Acceptance and willing to repeat colonoscopy were significantly better for SPMC with all the scales. Compliance was less than full in 6.6 and 9.9% of cases with PEG-ASC and SPMC, respectively (P = 0.17). Nausea and meteorism were significantly more bothersome with PEG-ASC than SPMC. There were no serious adverse events in either group. Conclusion SPMC and PEG-ASC are not different in terms of efficacy, but SPMC is better tolerated than PEG-ASC. SPMC could be an alternative to low-volume PEG based purgative solutions for bowel preparation. Clinical trial registration [ClinicalTrials.gov], Identifier [NCT01649674 and EudraCT 2011-000587-10].
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Affiliation(s)
- Valentina D’Angelo
- Division of Gastroenterology and Digestive Endoscopy, Department of Abdominal Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
| | - Maria Carmela Piccirillo
- Clinical Trial Unit, Department of Translational Research, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, Ospedale Mauriziano, University of Turin, Torino, Italy
| | - Ciro Gallo
- Medical Statistics Unit, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Cristina Bucci
- Division of Gastroenterology and Digestive Endoscopy, Department of Abdominal Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
| | - Corrado Civiletti
- Division of Gastroenterology and Digestive Endoscopy, Department of Abdominal Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
| | - Elena Di Girolamo
- Division of Gastroenterology and Digestive Endoscopy, Department of Abdominal Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
| | - Pietro Marone
- Division of Gastroenterology and Digestive Endoscopy, Department of Abdominal Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
| | - Giovanni Battista Rossi
- Division of Gastroenterology and Digestive Endoscopy, Department of Abdominal Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
| | - Alfonso Mario Tempesta
- Division of Gastroenterology and Digestive Endoscopy, Department of Abdominal Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
| | - Maura C. Tracey
- Unit for Rehabilitation Medicine, Department for the Support of Oncological Patients Pathways, Clinical Activities and Critical Area, Istituto Nazionale Tumori–IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Marco Romano
- Division of Gastroenterology, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Agnese Miranda
- Division of Gastroenterology, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Domenico Taranto
- Division of Gastroenterology, Clinica Mediterranea, Napoli, Italy
| | - Gabriella Sessa
- Division of Gastroenterology, Clinica Mediterranea, Napoli, Italy
| | - Pasquale Esposito
- Division of Gastroenterology, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Raffaele Salerno
- Division of Gastroenterology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Rossella Pumpo
- Digestive Endoscopy Unit, Ospedale S. Maria del Loreto Nuovo, Napoli, Italy
| | | | | | - Mario de Bellis
- Division of Gastroenterology and Digestive Endoscopy, Department of Abdominal Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy,*Correspondence: Mario de Bellis, ; orcid.org/0000-0001-5976-6279
| | - Francesco Perrone
- Clinical Trial Unit, Department of Translational Research, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
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Dziechciarz P, Ruszczyński M, Horvath A. Sodium Picosulphate with Magnesium Citrate versus Polyethylene Glycol for Bowel Preparation in Children: A Systematic Review. Pediatr Gastroenterol Hepatol Nutr 2022; 25:228-239. [PMID: 35611374 PMCID: PMC9110845 DOI: 10.5223/pghn.2022.25.3.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the effectiveness, tolerability, acceptability, and safety of sodium picosulphate with magnesium citrate (PS/Mg) and polyethylene glycol (PEG) in children (≤18 years) preparing for colonoscopy. Methods Three electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) were searched till July 2020. Only randomized controlled trials (RCTs) were included. At least two authors independently selected studies and performed risk of bias assessment and data extraction. Results Four RCTs (n=390), with overall good quality were included. A meta-analysis of two trials (n=224) found no statistically significant difference between the groups with respect to the proportion of patients who had excellent and good scores (≥6 points) according to the Boston Bowel Preparation Scale (relative risk: 0.99; 95% confidence interval [CI]: 0.90 to 1.08). Excellent and good scores were observed in both groups in approximately 90% of children. A meta-analysis of two other trials (n=150) showed no significant difference between the groups with respect to the mean total score for the Ottawa Bowel Preparation Scale (mean difference: 0.20; 95% CI: -0.74 to 1.14). Both regimens provided a comparable safety profile; however, PS/Mg was significantly superior to high volume PEG in terms of tolerability (abdominal pain, nausea, vomiting, bloating/flatulence/fullness) and acceptability (ease of formulation consumption, taste acceptance, need for nasogastric tube, compliance with full dose). Conclusion PS/Mg provides a quality and safety profile similar to PEG for bowel cleansing; however, it has better acceptance and tolerance in children preparing for colonoscopy.
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Affiliation(s)
- Piotr Dziechciarz
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Marek Ruszczyński
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Andrea Horvath
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
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Occhipinti V, Soriani P, Bagolini F, Milani V, Rondonotti E, Annunziata ML, Cavallaro F, Vavassori S, Vecchi M, Pastorelli L, Tontini GE. Efficacy and tolerability of high and low-volume bowel preparation compared: A real-life single-blinded large-population study. World J Gastrointest Endosc 2021; 13:659-672. [PMID: 35070027 PMCID: PMC8716982 DOI: 10.4253/wjge.v13.i12.659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/25/2021] [Accepted: 12/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low-volume preparations for colonoscopy have shown similar efficacy compared to high-volume ones in randomized controlled trials (RCT). However, most RCTs do not provide data about clinical outcomes including lesions detection rate. Moreover, real-life comparisons are lacking.
AIM To compare efficacy (both in terms of adequate bowel preparation and detection of colorectal lesions) and tolerability of a high-volume (HV: 4 L polyethylene glycol, PEG) and a low-volume (LV: 2 L PEG plus bisacodyl) bowel preparation in a real-life setting.
METHODS Consecutive outpatients referred for colonoscopy were prospectively enrolled between 1 December 2014 and 31 December 2016. Patients could choose either LV or HV preparation, with a day-before schedule for morning colonoscopies and a split-dose for afternoon procedures. Adequate bowel preparation according to Boston Bowel Preparation Scale (BBPS), clinical outcomes including polyp detection rate (PDR), adenoma detection rate (ADR), advanced adenoma detection rate (AADR), sessile/serrated lesion detection rate (SDR) and cancer detection rate and self-reported tolerability of HV and LV were blindly assessed.
RESULTS Total 2040 patients were enrolled and 1815 (mean age 60.6 years, 50.2% men) finally included. LV was chosen by 52% of patients (50.8% of men, 54.9% of women). Split-dose schedule was more common with HV (44.7% vs 38.2%, P = 0.005). High-definition scopes were used in 33.4% of patients, without difference in the two groups (P = 0.605). HV and LV preparations showed similar adequate bowel preparation rates (89.2% vs 86.6%, P = 0.098), also considering the two different schedules (HV split-dose 93.8% vs LV split-dose 93.6%, P = 1; HV day-before 85.5% vs LV day-before 82.3%, P = 0.182). Mean global BBPS score was higher for HV preparations (7.1 ± 1.7 vs 6.8 ± 1.6, P < 0.001). After adjustment for sex, age and indications for colonoscopy, HV preparation resulted higher in PDR [Odds ratio (OR) 1.32, 95%CI: 1.07-1.63, P = 0.011] and ADR (OR 1.29, 95%CI 1.02–1.63, P = 0.038) and comparable to LV in AADR (OR 1.51, 95%CI 0.97-2.35, P = 0.069), SDR and cancer detection rate. The use of standard-definition colonoscopes was associated to lower PDR (adjusted OR 1.59, 95%CI: 1.22-2.08, P < 0.001), ADR (adjusted OR 1.71, 95%CI: 1.26–2.30, P < 0.001) and AADR (adjusted OR 1.97, 95%CI: 1.09-3.56, P = 0.025) in patients receiving LV preparation. Mean Visual Analogue Scale tolerability scored equally (7, P = 0.627) but a ≥ 75% dose intake was more frequent with LV (94.6% vs 92.1%, P = 0.003).
CONCLUSION In a real-life setting, PEG-based low-volume preparation with bisacodyl showed similar efficacy and tolerability compared to standard HV preparation. However, with higher PDR and ADR, HV should still be considered as the reference standard for clinical trials and the preferred option in screening colonoscopy, especially when colonoscopy is performed with standard resolution imaging.
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Affiliation(s)
- Vincenzo Occhipinti
- Digestive Endoscopy and Gastroenterology Unit, A. Manzoni Hospital, ASST Lecco, Lecco 23900, Italy
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
| | - Paola Soriani
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Carpi Hospital, Carpi 41012, Italy
| | - Francesco Bagolini
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
| | | | | | - Flaminia Cavallaro
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Sara Vavassori
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Hepatology Unit, ASST Santi Paolo e Carlo, Milan 20142, Italy
| | - Maurizio Vecchi
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
| | - Luca Pastorelli
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Hepatology Unit, ASST Santi Paolo e Carlo, Milan 20142, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan 20122, Italy
| | - Gian Eugenio Tontini
- Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
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Ray-Offor E, Jebbin N. Risk Factors for Inadequate Bowel Preparation During Colonoscopy in Nigerian Patients. Cureus 2021; 13:e17145. [PMID: 34532179 PMCID: PMC8435095 DOI: 10.7759/cureus.17145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 02/07/2023] Open
Abstract
Background The past few decades have witnessed the introduction of various innovative technologies into colon study by colonoscopy. A well-prepared bowel is crucial to their effective utilization. An inadequate bowel preparation during colonoscopy is associated with increased technical difficulties, enhanced risks of perforation, longer examination durations, reduced adenoma detection rates, and additional costs related to repeated colonoscopies. There is a paucity of literature from Africa on the multiple patient factors that affect the quality of bowel preparation; hence, the need to identify patients at risk for inadequate bowel preparation to allow for more diligence in this special group. Aim To study the risk factors of inadequate bowel preparation for colonoscopy and identify the group of patients who need intensified preparation in a Nigerian population. Methods A case-control study of consecutive patients undergoing colonoscopy in an open access/referral-based multi-disciplinary endoscopy facility in Port Harcourt metropolis, Nigeria from March 2014 to November 2020. Consecutive adult patients who underwent colonoscopy with inadequate bowel preparation irrespective of the indication were retrospectively identified. Each case of inadequate bowel preparation while using a particular bowel preparation agent was matched with the next colon study with adequate bowel preparation (control) for the same agent in a 1:1 ratio. The variables collated were age, gender, literacy level, colonoscopy indication, medical history, bowel preparation agent, timing of endoscopy, and outcome. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY). Results There were 143 cases of inadequate bowel preparation during colonoscopy included in the study with an equal number of control (cases of adequate bowel preparation). The age of patients ranged from 24 years to 92 years. Bleeding per rectum - 122(42.7%), and screening for colorectal cancer - 67(23.4%), were the leading indications for colonoscopy in study patients. Bivariate analysis of cases and controls revealed significant difference in educational status, comorbidity of hypertension, and constipation (p < 0.01, p = 0.082, p = 0.143, respectively). In the multivariate analysis of risk factors, the odds ratio (OR) for secondary level of education and below was 2.54 (95% confidence interval CI 1.50-4.30; p = 0.001); hypertension - OR 1.64 (95% CI 0.98-2.73; p = 0.058); constipation - OR 1.27 (95% CI 0.52-3.10; p = 0.598). Conclusion The educational status of patients is a strong risk factor associated with inadequate bowel preparation for colonoscopy in this Nigerian population. There is a need for effective patient education especially for patients with a low literacy level.
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Affiliation(s)
- Emeka Ray-Offor
- Digestive Disease Unit, Oak Endoscopy Centre, Port Harcourt, NGA
- Colorectal and Minimal Access Surgery Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, NGA
| | - Nze Jebbin
- Colorectal and Minimal Access Surgery Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, NGA
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Na SY, Moon W. [Optimal Laxatives for Oral Colonoscopy Bowel Preparation: from High-volume to Novel Low-volume Solutions]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2020; 75:65-73. [PMID: 32098459 DOI: 10.4166/kjg.2020.75.2.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
Optimal bowel preparation is essential for a more accurate, comfortable, and safe colonoscopy. The majority of postcolonoscopy colorectal cancers can be explained by procedural factors, mainly missed polyps or inadequate examination. Therefore the most important goal of optimal bowel preparation is to reduce the incidence of colorectal cancer. Although adequate preparation should be achieved in 85-90% or more of all colonoscopy as a quality indicator, unfortunately 20-30% shows inadequate preparation. Laxatives for oral colonoscopy bowel preparation can be classified into polyethylene glycol (PEG)-electrolyte lavage solution, osmotic laxatives, stimulant laxatives, and divided into high-volume solution (≥3 L) and low-volume solution (<3 L). The updated 2019 European Society of Gastrointestinal Endoscopy (ESGE) guideline is broadly similar to the 2014 American Society for Gastrointestinal Endoscopy (ASGE) recommendations and reaffirms the importance of split-dosing. However, new ESGE guideline, unlike the 2014 ASGE recommendation, suggests the use of high volume or low volume PEG-based regimens as well as that of non-PEG based agents that have been clinically validated for most outpatient scenarios. For effective, safe, and highly adherent bowel preparation, physicians who prescribe and implement colonoscopy should properly know the advantages and limitations, the dosing, and the timing of regimens. Recently many studies have attempted to find the most ideal regimens, and more convenient, effective, and safe regimens have been developed by reducing the dosing volume and improving the taste. The high tolerability and acceptability of the new low-volume regimens suggest us how we should use it to increase the participation of the national colorectal cancer screening program.
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Affiliation(s)
- Soo-Young Na
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Kim B, Kim BC, Kim J, Oh HJ, Ryu KH, Park BJ, Sohn DK, Hong CW, Han KS. Quality of Bowel Preparation for Colonoscopy in Patients with a History of Abdomino-Pelvic Surgery: Retrospective Cohort Study. Yonsei Med J 2019; 60:73-78. [PMID: 30554493 PMCID: PMC6298899 DOI: 10.3349/ymj.2019.60.1.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/24/2018] [Accepted: 11/07/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Prior abdomino-pelvic (AP) surgery makes colonoscopy difficult and can affect bowel preparation quality. However, bowel preparation quality has been found to vary according to prior AP surgery type. We examined the relationship of prior AP surgery type with bowel preparation quality in a large-scale retrospective cohort. MATERIALS AND METHODS In the health screening cohort of the National Cancer Center, 12881 participants who underwent screening or surveillance colonoscopy between June 2007 and December 2014 were included. Personal data were collected by reviewing patient medical records. Bowel preparation quality was assessed using the Aronchick scale and was categorized as satisfactory for excellent to good bowel preparation or unsatisfactory for fair to inadequate bowel preparation. RESULTS A total of 1557 (12.1%) participants had a history of AP surgery. The surgery types were colorectal surgery (n=44), gastric/small intestinal surgery (n=125), appendectomy/peritoneum/laparotomy (n=476), cesarean section (n=278), uterus/ovarian surgery (n=317), kidney/bladder/prostate surgery (n=19), or liver/pancreatobiliary surgery (n=96). The proportion of satisfactory bowel preparations was 70.7%. In multivariate analysis, unsatisfactory bowel preparation was related to gastric/small intestinal surgery (odds ratio=1.764, 95% confidence interval=1.230-2.532, p=0.002). However, the other surgery types did not affect bowel preparation quality. Current smoking, diabetes, and high body mass index were risk factors of unacceptable bowel preparation. CONCLUSION Only gastric/small intestinal surgery was a potential risk factor for poor bowel preparation. Further research on patients with a history of gastric/small intestinal surgery to determine appropriate methods for adequate bowel preparation is mandatory.
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Affiliation(s)
- Bun Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Jeongseon Kim
- Department of Cancer Biomedical Science, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyun Jin Oh
- Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kum Hei Ryu
- Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Bum Joon Park
- Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Rocha RSDP, Ribeiro IB, de Moura DTH, Bernardo WM, Minata MK, Morita FHA, Aquino JCM, Baba ER, Miyajima NT, de Moura EGH. Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients? A systematic review and meta-analysis. World J Gastrointest Endosc 2018; 10:422-441. [PMID: 30631405 PMCID: PMC6323500 DOI: 10.4253/wjge.v10.i12.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/17/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the best option for bowel preparation [sodium picosulphate or polyethylene glycol (PEG)] for elective colonoscopy in adult outpatients.
METHODS A systematic review of the literature following the PRISMA guidelines was performed using Medline, Scopus, EMBASE, Central, Cinahl and Lilacs. No restrictions were placed for country, year of publication or language. The last search in the literature was performed on November 20th, 2017. Only randomized clinical trials with full texts published were included. The subjects included were adult outpatients who underwent bowel cleansing for elective colonoscopy. The included studies compared sodium picosulphate with magnesium citrate (SPMC) and PEG for bowel preparation. Exclusion criteria were the inclusion of inpatients or groups with specific conditions, failure to mention patient status (outpatient or inpatient) or dietary restrictions, and permission to have unrestricted diet on the day prior to the exam. Primary outcomes were bowel cleaning success and/or tolerability of colon preparation. Secondary outcomes were adverse events, polyp and adenoma detection rates. Data on intention-to-treat were extracted by two independent authors and risk of bias assessed through the Jadad scale. Funnel plots, Egger’s test, Higgins’ test (I2) and sensitivity analyses were used to assess reporting bias and heterogeneity. The meta-analysis was performed by computing risk difference (RD) using Mantel-Haenszel (MH) method with fixed-effects (FE) and random-effects (RE) models. Review Manager 5 (RevMan 5) version 6.1 (The Cochrane Collaboration) was the software chosen to perform the meta-analysis.
RESULTS 662 records were identified but only 16 trials with 6200 subjects were included for the meta-analysis. High heterogeneity among studies was found and sensitivity analysis was needed and performed to interpret data. In the pooled analysis, SPMC was better for bowel cleaning [MH FE, RD 0.03, IC (0.01, 0.05), P = 0.003, I2 = 33%, NNT 34], for tolerability [MH RE, RD 0.08, IC (0.03, 0.13), P = 0.002, I2 = 88%, NNT 13] and for adverse events [MH RE, RD 0.13, IC (0.05, 0.22), P = 0.002, I2 = 88%, NNT 7]. There was no difference in regard to polyp and adenoma detection rates. Additional analyses were made by subgroups (type of regimen, volume of PEG solution and dietary recommendations). SPMC demonstrated better tolerability levels when compared to PEG in the following subgroups: “day-before preparation” [MH FE, RD 0.17, IC (0.13, 0.21), P < 0.0001, I2 = 0%, NNT 6], “preparation in accordance with time interval for colonoscopy” [MH RE, RD 0.08, IC (0.01, 0.15), P = 0.02, I2 = 54%, NNT 13], when compared to “high-volume PEG solutions” [MH RE, RD 0.08, IC (0.01, 0.14), I2 = 89%, P = 0.02, NNT 13] and in the subgroup “liquid diet on day before” [MH RE, RD 0.14, IC (0.06,0.22), P = 0.0006, I2 = 81%, NNT 8]. SPMC was also found to cause fewer adverse events than PEG in the “high-volume PEG solutions” [MH RE, RD -0.18, IC (-0.30, -0.07), P = 0.002, I2 = 79%, NNT 6] and PEG in the “low-residue diet” subgroup [MH RE, RD -0.17, IC (-0.27, 0.07), P = 0.0008, I2 = 86%, NNT 6].
CONCLUSION SPMC seems to be better than PEG for bowel preparation, with a similar bowel cleaning success rate, better tolerability and lower prevalence of adverse events.
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Affiliation(s)
- Rodrigo Silva de Paula Rocha
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Maurício Kazuyoshi Minata
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Flávio Hiroshi Ananias Morita
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Júlio Cesar Martins Aquino
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Elisa Ryoka Baba
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Nelson Tomio Miyajima
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
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Tan L, Lin ZC, Ma S, Romero L, Warrier S. Bowel preparation for colonoscopy. Hippokratia 2018. [DOI: 10.1002/14651858.cd006330.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lynn Tan
- Monash University; Faculty of Medicine, Nursing & Health Sciences; 1-131 Wellington Road Clayton Victoria Australia 3168
| | - Zhiliang Caleb Lin
- The Alfred Hospital; Surgical Services; 55 Commercial Road Melbourne Victoria Australia 3004
| | - Stefan Ma
- Ministry of Health Singapore; Epidemiology and Disease Control Division, Public Health Group, Ministry of Health; 16 College Road, College of Medicine Building Singapore Singapore Singapore 169854
| | - Lorena Romero
- The Alfred Hospital; The Ian Potter Library; 55 Commercial Road Melbourne Victoria Australia 3000
| | - Satish Warrier
- Alfred Health; Colorectal Department; 55 Commercial Road Melbourne Victoria Australia 3004
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