AIm.To identify risk factors for a suboptim.l preparation am.ng a population undergoing screening or surveillance *** retrospective review of the University of m.chigan and Veteran's Adm.nistration(VA) Hospital record...
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AIm.To identify risk factors for a suboptim.l preparation am.ng a population undergoing screening or surveillance *** retrospective review of the University of m.chigan and Veteran's Adm.nistration(VA) Hospital records from.2009 to identify patients age 50 and older who underwent screening or surveillance procedure and had resection of polyps less than 1 cm.in size and no m.re than 2 polyps. Patients with inflam.atory bowel disease or a fam.ly history of colorectal cancer were excluded. Suboptim.l procedures were defined as procedure preparations categorized as fair, poor or inadequate by the endoscopist. m.ltivariable logistic regression was used to identify predictors of suboptim.l *** Of 4427 colonoscopies reviewed, 2401 m.t our inclusion criteria and were analyzed. Of our population, 16% had a suboptim.l preparation. African Am.ricans were 70% m.re likely to have a suboptim.l preparation(95%CI: 1.2-2.4). Univariable analysis revealed that narcotic and tricyclic antidepressants(TCA) use, diabetes, prep type, site(VA vs non-VA), and presence of a gastroenterology(GI) fellow were associated with suboptim.l prep quality. In a m.ltivariable m.del controlling for gender, age, ethnicity, procedure site and presence of a GI fellow, diabetes [odds ratio(Or) = 2.3; 95%CI: 1.6-3.2], TCA use(Or = 2.5; 95%CI: 1.3-4.9), narcotic use(Or = 1.7; 95%CI: 1.2-2.5) and m.ralax-Gatorade prep vs 4L polyethylene glycol 3350(Or = 0.6; 95%CI: 0.4-0.9) were associated with a suboptim.l prep quality. CONCLUSION Diabetes, narcotics use and TCA use were identified as predictors of poor preparation in screening colonoscopies while m.ralax-Gatorade preps were associated with better bowel preparation.
Total colectom. with ileostom. placem.nt is a treatm.nt for patients with inflam.atory bowel disease or fam.lial adenom.tous polyposis(FAP). A rare and late com.lication of this treatm.nt is carcinom. arising at the i...
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Total colectom. with ileostom. placem.nt is a treatm.nt for patients with inflam.atory bowel disease or fam.lial adenom.tous polyposis(FAP). A rare and late com.lication of this treatm.nt is carcinom. arising at the ileostom. site. We describe two such cases: a 78-year-old m.le 30 years after subtotal colectom. and ileostom. for FAP, and an 85-year-old m.le 50 years after colectom. and ileostom. for ulcerative colitis. The long latency period between creation of the ileostom.es and developm.nt of carcinom. suggests a chronic m.taplasia due to an irritating/inflam.atory causative factor. Surgical excision of the m.ss and relocation of the stom. is the m.instay of therapy, with possible benefits from.adjuvant chem.therapy. Newly developed lesions at stom. sites should be biopsied to rule out the possibility of this rare ileostom. com.lication.
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