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Bowel preparation quality scales for colonoscopy

World Journal of Gastroenterology 2018年第26期24卷 2833-2843页

作者： David Kastenberg Gerald Bertiger Stuart Brogadir Division of Gastroenterology and Hepatology Department of MedicineThomas Jefferson UniversityPhiladelphiaPA 19107United States Hillmont GI FlourtownPA 19031United States Medical Affairs Ferring PharmaceuticalsIncParsippanyNJ 07054United States

Colorectal cancer(CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred to in the literature, these differ greatly in grading methodology and categorization criteria. Published reliability and validity data are available for five bowel preparation quality assessment scales, which vary in several key attributes. However, clinicians and researchers continue to use a variety of bowel preparation quality measures, including nonvalidated scales, leading to potential confusion and difficulty when comparing quality results among clinicians and across clinical trials. Optimal clinical criteria for bowel preparation quality remain controversial. The use of validated bowel preparation quality scales with stringent but simple scoring criteria would help clarify clinical trial data as well as the performance of colonoscopy in clinical practice related to quality measurements.

关键词： Colonoscopy Bowel preparation Aronchick scale Ottawa Bowel Preparation Scale Boston Bowel Preparation Scale

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Multicenter,randomized study to optimize bowel for colon capsule endoscopy

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World Journal of Gastroenterology 2017年第48期23卷 8615-8625页

作者： David Kastenberg Wilmot C Burch Jr david P Romeo Pankaj K Kashyap david C Pound Neophytos Papageorgiou Ignacio Fernández-Urien Sainz Carly E Sokach Douglas K Rex Division of Gastroenterology Thomas Jefferson University Franklin Gastroenterology PLLC Dayton Gastroenterology Inc. Pinnacle Research Group LLC Indianapolis Gastroenterology and hepatology Department of Gastroenterology American Medical Center Department of Gastroenterology Servicio de Digestivohospital de Navarra Sidney Kimmel Medical College at Thomas Jefferson University Indiana University hospital

AIM To assess the cleansing efficacy and safety of a new Colon capsule endoscopy(CCE) bowel preparation regimen.METHODS This was a multicenter,prospective,randomized,controlled study comparing two CCE regimens. Subjects were asymptomatic and average risk for colorectal cancer. The second generation CCE system(Pill Cam? COLON 2;Medtronic,Yoqneam,Israel) was utilized. Preparation regimens differed in the 1 st and 2 nd boosts with the Study regimen using oral sulfate solution(89 m L) with diatrizoate meglumine and diatrizoate sodium solution("diatrizoate solution")(boost 1 = 60 m L,boost 2 = 30 m L) and the Control regimen oral sulfate solution(89 m L) alone. The primary outcome was overall and segmental colon cleansing. Secondary outcomes included safety,polyp detection,colonic transit,CCE completion and capsule excretion ≤ 12 h. RESULTS Both regimens had similar cleansing efficacy for the whole colon(Adequate: Study = 75.9%,Control = 77.3%;P = 0.88) and individual segments. In the Study group,CCE completion was superior(Study = 90.9%,Control = 76.9%;P = 0.048) and colonic transit was more often < 40 min(Study = 21.8%,Control = 4%;P = 0.0073). More Study regimen subjects experienced adverse events(Study = 19.4%,Control = 3.4%;P = 0.0061),and this difference did not appear related to diatrizoate solution. Adverse events were primarily gastrointestinal in nature and no serious adverse events related either to the bowel preparation regimen or the capsule were observed. There was a trend toward higher polyp detection with the Study regimen,but this did not achieve statistical significance for any size category. Mean transit time through the entire gastrointestinal tract,from ingestion to excretion,was shorter with the Study regimen while mean colonic transit times were similar for both study groups.CONCLUSION A CCE bowel preparation regimen using oral sulfate solution and diatrizoate solution as a boost agent is effective,safe,and achieved superior CCE completion.

关键词： Bowel preparation Purgative Capsule endoscopy Endoscopy Capsule colonoscopy Large intestine

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