Electrolyte changes after bowel preparation for colonoscopy:A randomized controlled multicenter trial

AIM:To investigate the electrolyte changes between 2-L polyethylene glycol with ascorbic acid 20 g(PEGAsc) and 4-L PEG solutions.METHODS:From August 2012 to February 2013,a total of 226 patients were enrolled at four tertiary hospitals.All patients were randomly allocated to a PEG-Asc group or a 4-L PEG.Before colonoscopy,patients completed a questionnaire to assess bowel preparation-related symptoms,satisfaction,and willingness.Endoscopists assessed the bowel preparation using the Boston Bowel Preparation Scale(BBPS).In addition,blood tests,including serum electrolytes,serum osmolarity,and urine osmolarity were evaluated both before and after the procedure.RESULTS:A total of 226 patients were analyzed.BBPS scores were similar and the adequate bowel preparation rate(BBPS≥6)was not different between the two groups(PEG-Asc vs 4-L PEG,73.2%vs 76.3%,P=0.760).Bowel preparation-related symptoms also were not different between the two groups.The taste of PEG-Asc was better(41.1%vs 16.7%,P<0.001),and the willingness to undergo repeated bowel preparation was higher in the PEG-Asc group(73.2%vs 59.3%,P=0.027)than in 4-L PEG.There were no significant changes in serum electrolytes in either group.CONCLUSION:In this multicenter trial,bowel preparation with PEG-Asc was better than 4-L PEG in terms of patient satisfaction,with similar degrees of bowel preparation and electrolyte changes.

Placement of a fully covered self-expandable metal stent in a young patient with chronic pancreatitis

Plastic stent insertion is a treatment option for pancreatic duct stricture with chronic pancreatitis.However, recurrent stricture is a limitation after removing the plastic stent.Self-expandable metal stents have long diameters and patency.A metal stent has become an established management option for pancreatic duct stricture caused by malignancy but its use in benign stricture is still controversial.We introduce a young patient who had chronic pancreatitis and underwent several plastic stent insertions due to recurrent pancreatic duct stricture.His symptoms improved after using a fully covered self-expandable metal covered stent and there was no recurrence found at follow-up at the outpatient department.

Acetylsalicylic acid for metal stent in malignant distal common bile duct obstruction:A randomized controlled trial

Background:Endoscopic biliary drainage is the treatment of choice for patients with malignant distal common bile duct obstruction.Self-expandable metal stents have clinical advantages including an increased duration of patency that may be prolonged by acetylsalicylic acid(ASA)use.The aim of this study was to investigate whether ASA had a positive effect on the patency of self-expandable metal stents compared with placebo.Methods:This prospective,multicenter,double-blinded,and randomized placebo-controlled trial was conducted from October 2017 to May 2020 in Korea.Patients who underwent palliative endoscopic biliary drainage with self-expandable metal stents for malignant distal bile duct obstruction were enrolled,and allocated to ASA treatment or placebo.The study outcomes were the rate of stent dysfunction at 6 months,duration of stent patency,risk factors for stent dysfunction,and any adverse events.Results:Interim analysis included 24 and 28 patients in the ASA and placebo groups,respectively.There was no significant difference between the ASA and placebo groups in stent dysfunction(25.0%vs.20.7%,P=0.761)or the duration of stent patency(150.97±10.55 vs.158.07±8.70 days,P=0.497).Six patients experienced suspected ASA-related adverse events,and there was one lethal case.Conclusions:ASA did not prolong stent patency.This study was terminated early because of the possibility of serious adverse events related to ASA treatment of these patients receiving palliative care.

Cholecystectomy increases the risk of metabolic syndrome in the Korean population:a longitudinal cohort study

Background:Cholecystectomy is a common surgical procedure to treat symptomatic gallstones;however,the long-term outcomes after cholecystectomy are unknown.Therefore,we aimed to investigate whether incident metabolic syndrome(MetS)is associated with cholecystectomy through a large,population-based,longitudinal study.Methods:Subjects aged≥20 years who underwent cholecystectomy from 2010 to 2014(n=76,485)and controls(n=76,485),matched for age and sex,were identified from the Korean National Health Insurance Corporation.Cox proportional hazards analyses were performed to evaluate the association between cases and incident MetS,and hazard ratios and 95% confidence intervals(CIs)were calculated.Results:A total of 152,970 patients were included.Mean age was 52.47±12.76 years,and 50.65% of participants were male.During the follow-up period,there were 38,979(25.48%)newly diagnosed MetS cases in the study participants.The risk of MetS in the cholecystectomy group was approximately 20% higher than that in the control group[adjusted odds ratio(OR),1.20;95%CI:1.17-1.23].In the fully adjusted models,the corresponding ORs for new-onset high waist circumference(WC),low high-density lipoprotein cholesterol(HDL-C)levels,high triglycerides(TG)levels,high blood pressure(BP),and high blood glucose levels were 1.16(1.13-1.19),1.19(1.16-1.22),1.25(1.22-1.28),1.27(1.23-1.31),and 1.21(1.18-1.24),respectively.Cholecystectomy was an independent risk factor of incident MetS,after adjusting for potential confounding factors.In the subgroup analyses,the cholecystectomy group had a higher risk of MetS than the control group in subjects without hypertension or dyslipidemia,respectively.Conclusions:In this large,population-based study,cholecystectomy was associated with an increased risk of developing MetS,independent of other confounding factors.Therefore,careful monitoring of metabolic variables and long-term follow-up are required to evaluate MetS risk after cholecystectomy.