Cap-assisted endoscopy for esophageal foreign bodies:A metaanalysis

BACKGROUND Esophageal foreign bodies are common around the world.Newer approaches,such as cap-assisted endoscopy,have been introduced as an alternative to conventional methods.Therefore,we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.METHODS An extensive literature search was performed(December 2021).For esophageal foreign body removal,cap-assisted endoscopy was compared to conventional endoscopy for procedure time,technical success of the procedure,time of foreign body retrieval,en bloc removal,and adverse event rate using odds ratio and mean difference.RESULTS Six studies met the inclusion criteria(n=1305).Higher odds of technical success(P=0.002)and en bloc removal(P<0.01)and lower odds of adverse events(P=0.02)and foreign body removal time(P<0.01)were observed with cap-assisted endoscopy as compared to conventional techniques.CONCLUSION For esophageal foreign bodies,the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.

Diagnostic accuracy of endoscopic ultrasound in pancreatic neuroendocrine tumors: A systematic review and meta analysis

AIM: To detect pancreatic neuroendocrine tumors (PNETs) has been varied. This study is undertaken to evaluate the accuracy of endoscopic ultrasound (EUS) in detecting PNETs.METHODS: Only EUS studies confirmed by surgery or appropriate follow-up were selected. Articles were searched in Medline, Ovid journals, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Pooling was conducted by both fixed and random effects model). RESULTS: Initial search identified 2610 reference articles, of these 140 relevant articles were selected and reviewed. Data was extracted from 13 studies (n = 456) which met the inclusion criteria. Pooled sensitivity of EUS in detecting a PNETs was 87.2% (95%CI: 82.2-91.2). EUS had a pooled specificity of 98.0% (95%CI: 94.3-99.6). The positive likelihood ratio of EUS was 11.1 (95%CI: 5.34-22.8) and negative likelihood ratio was 0.17 (95%CI: 0.13-0.24). The diagnostic odds ratio, the odds of having anatomic PNETs in positive as compared to negative EUS studies was 94.7 (95%CI: 37.9-236.1). Begg-Mazumdar bias indicator for publication bias gave a Kendall's tau value of 0.31 (P = 0.16), indication no publication bias. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity to detect PNETs. EUS should be strongly considered for evaluation of PNETs.

How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) for staging of gastric cancers. METHODS: Only EUS studies confirmed by surgery were selected. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Articles were searched in Medline, Pubmed, Ovid journals, Cumulative index for nursing & allied health literature, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane control trial registry. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. 2 × 2 tables were constructed with the data extracted from each study. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specifi city, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fi xed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights. RESULTS: Initial search identified 1620 reference articles and of these, 376 relevant articles were selected and reviewed. Twenty-two studies (n = 1896) which met the inclusion criteria were included in this analysis. Pooled sensitivity of T1 was 88.1% (95% CI: 84.5-91.1) and T2 was 82.3% (95% CI: 78.2-86.0). For T3, pooled sensitivity was 89.7% (95% CI: 87.1-92.0). T4 hada pooled sensitivity of 99.2% (95% CI: 97.1-99.9). For nodal staging, the pooled sensitivity for N1 was 58.2% (95% CI: 53.5-62.8) and N2 was 64.9% (95% CI: 60.8-68.8). Pooled sensitivity to diagnose distant metastasis was 73.2% (95% CI: 63.2-81.7). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS results are more accurate with advanced disease than early disease. If EUS diagnoses advanced disease, such as T4 disease, the patient is 500 times more likely to have true anatomic stage of T4 disease.

Staging accuracy of esophageal cancer by endoscopic ultrasound:A meta-analysis and systematic review

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS: Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ2 test of heterogeneity for all pooled estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.

Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis:A systematic review and meta-analysis

AIM: To conduct a systemic review and meta-analysis to investigate the role of early precut technique. Multiple randomized controlled trails (RCTs) have reported conflicting results of the early precut sphincterotomy.

Bowel preparation prior to colonoscopy:A continual search for excellence

Bowel preparation prior to colonoscopy is essential to maximize the benefits of colonoscopy.Numerous bowel preparations have been studied,ranging from 4 L polyethylene glycol(PEG) to split-dose regimens to 2 L PEG with an adjunct laxative(senna,bisacodyl,ascorbic acid).Due to the large volume of PEG required for adequate bowel preparation,many studies have focused on reducing this large volume to only 2 L PEG with the addition of an adjunct.Recently,a randomized controlled trial by Tajika et al showed that the addition of mosapride to only 1.5 L PEG was non-inferior to mosapride and 2 L PEG for bowel cleansing but did provide improvements in patient tolerance.This study offers yet another potential bowel preparation for patients undergoing colonoscopy and may trigger further studies with 1.5 L PEG with an adjunct.In this letter,we discuss the current state of bowel preparation prior to colonoscopy and offer information to guide clinicians on choosing the appropriate bowel preparation for their patients.

Effect of music on patients undergoing outpatient colonoscopy

AIM: To evaluate the effect of relaxing music during colonoscopy under low-dose conscious sedation, on patient satisfaction, scope insertion time and procedure duration, medication doses, and the perceived adequacy of sedation and scope insertion difficulty on the part of the endoscopist. METHODS: One hundred and sixty-seven consecutive adult outpatients presenting for routine colonoscopy under low-dose conscious sedation were randomized to undergo their procedures either with music played during the procedure or no music played. RESULTS: There were no statistical differences between the two groups in terms of meperidine dose, midazolam dose, time to reach the cecum, total procedure time, endoscopist assessment of scope insertion difficulty, endoscopist assessment of adequacy of sedation, or the pain experience of the patients during their procedure. The music group did report significantly better overall procedure satisfaction as compared to the non music group on two of our three different scales. CONCLUSION: While music does not result in shortened procedure times, lower doses of sedative medications or perceived patient pain, the patients who have music playing during their procedures report modestly greater satisfaction with their procedures.

Endoscopic ultrasound:It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS:Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI:82.9-86.4) to 88.0% (95% CI:85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI:83.2-85.9) to 96.4% (95% CI:95.3-97.4). The P forchi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION:EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.

Bravo (wireless) ambulatory esophageal pH monitoring: How do day 1 and day 2 results compare?

AIM： To investigate if differences exist for patients＇ gastroesophageal reflux as measured by the Bravo ambulatory esophageal pH system between d 1 and d 2.METHODS： A retrospective study of 27 consecutive adult patients who underwent Bravo esophageal pH monitoring was performed. Patients underwent EGD under Ⅳ conscious sedation prior to Bravo placement. Acid reflux variables and symptom scores for d 1 were compared to d 2.RESULTS： The mean doses of fentanyl and midazolam were 90.4 μg and 7.2 mg, respectively. D 1 results were significantly more elevated than d 2 with respect to total time pH 〈 4, upright position reflux, and mean number of long refluxes. No statistical difference was noted between the two days for supine position reflux, number of refluxes, duration of longest reflux, episodes of heartburn, and symptom score.CONCLUSION： Patients undergoing Bravo esophageal pH monitoring in association with EGD and moderate conscious sedation experience significantly more acid reflux on d i compared to d 2. The Ⅳ sedation may be responsible for the increased reflux on d 1. Performed this way, 48-h Bravo results may not be entirely representative of the patients＇ true GE reflux profile.

Endoscopic ultrasound-guided fiducial marker placement in pancreatic cancer:A systematic review and meta-analysis

BACKGROUND Pancreatic cancer(PC)mortality remains high despite advances in therapy.Combination chemoradiotherapy offers modest survival benefit over monotherapy with either.Fiducial markers serve as needed landmarks for imageguided radiotherapy(IGRT).Traditionally,these markers were placed surgically or percutaneously with limitations of each.Endoscopic ultrasound-guided placement overcomes these limitations.AIM To evaluate the safety,efficacy,and feasibility of endoscopic ultrasound(EUS)-guided fiducial placement for PC undergoing IGRT.METHODS Articles were searched in MEDLINE,PubMed,and Ovid journals.Pooling was conducted by fixed and random effects models.Heterogeneity was assessed using Cochran’s Q test based upon inverse variance weights.RESULTS Initial search identified 1024 reference articles for EUS-guided fiducial placement in PC.Of these,261 relevant articles were reviewed.Data was extracted from 11 studies(n=820)meeting inclusion criteria.Pooled proportion of successful placement was 96.27%(95%CI:95.35-97.81)with fiducial migration rates low at 4.33%(95%CI:2.45-6.71).Adverse event rates remained low,with overall pooled proportion of 4.85%(95%CI:3.04-7.03).CONCLUSION EUS-guided placement of fiducial markers for IGRT of PC is safe,feasible,and efficacious.The ability to target deep structures under direct visualization while remaining minimally invasive are added benefits.Moreover,the ability to perform fine needle aspiration or celiac plexus neurolysis add value and increase patient-care efficiency.Whether EUS-guided fiducial placement improves outcomes in IGRT or offers any mortality benefits over traditional placement remains unknown and future studies are needed.

Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis

AIM To perform meta-analysis of the use of Endocuff during average risk screening colonoscopy.METHODS Scopus, Cochrane databases, MEDLINE/Pub Med, and CINAHL were searched in April 2016. Abstracts from Digestive Disease Week, United European Gastroenterology, and the American College of Gastroenterology meeting were also searched from 2004-2015. Studies comparing EC-assisted colonoscopy(EAC) to standard colonoscopy, for any indication, were included in the analysis. The analysis was conducted by using the Mantel-Haenszel or DerS imonian and Laird models with the odds ratio(OR) to assess adenoma detection, cecal intubation rate, and complications performed. RESULTS Nine studies(n = 5624 patients) were included in the analysis. Compared to standard colonoscopy, procedures performed with EC had higher frequencies for adenoma(OR = 1.49, 95%CI: 1.23-1.80; P = 0.03), and sessile serrated adenomas detection(OR = 2.34 95%CI: 1.63-3.36; P < 0.001). There was no significant difference in cecal intubation rates between the EACgroup and standard colonoscopy(OR = 1.26, 95%CI: 0.70-2.27, I2 = 0%; P = 0.44). EAC was associated with a higher risk of complications, most commonly being superficial mucosal injury without higher frequency for perforation.CONCLUSION The use of an EC on colonoscopy appears to improve pre-cancerous polyp detection without any difference in cecal intubation rates compared to standard colonoscopy.

Bleeding risk with clopidogrel and percutaneous endoscopic gastrostomy

AIM To compare bleeding within 48 h in patients undergoing percutaneous endoscopic gastrostomy(PEG) with or without clopidogrel.METHODS After institutional review board approval, a retrospective study involving a single center was conducted on adult patients having PEG(1/08-1/14). Patients were divided into two groups: Clopidogrel group consisting of those patients taking clopidogrel within 5 d of PEG and the non-clopidogrel group including those patients not taking clopidogrel within 5 d of the PEG.RESULTS Three hundred and nineteen PEG patients were found. One hundred and sixty-eight males and 151 females with mean body mass index 28.47 ± 9.75 kg/m2 and mean age 65.03 ± 16.11 years were identified. Thirtythree patients were on clopidogrel prior to PEG with 286 patients not on clopidogrel. No patients in either group developed hematochezia, melena, or hematemesiswithin 48 h of percutaneous endoscopic gastrostomy(PEG). No statistical differences were observed between the two groups with 48 h for hemoglobin decrease of > 2 g/dL(2 vs 5 patients; P = 0.16), blood transfusions(2 vs 7 patients; P = 0.24), and repeat endoscopy for possible gastrointestinal bleeding(no patients in either group). CONCLUSION Based on the results, no significant post-procedure bleeding was observed in patients undergoing PEG with recent use of clopidogrel.

Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis

AIM： To evaluate usefulness of prophylactically intu-bating upper gastrointestinal bleeding （UGIB） patients. METHODS： UGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHL, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States （2004-2014）. Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and Laird models with results presented as odds ratio for aspiration, pneumonia （within 48 h）, and mortality. Funnel plots were utilized for publication bias and I2 measure of inconsistency for heterogeneity assessments. RESULTS： Initial search identi？ed 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors （Almashhrawi AA and Bechtold ML）. Of these studies, eight were excluded： Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies （N = 367） were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia （within 48 h） was identified in 20 of 134 （14.9%） patients as compared to 5 of 95 （5.3%） patients that were not intubated prophylactically （P = 0.02）. Despite observed trends, no significant differences were found for mortality （P = 0.18） or aspiration （ P = 0.11）.CONCLUSION： Pneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation prior to endoscopy.

Hyoscine for polyp detection during colonoscopy: A meta-analysis and systematic review

AIM: To assess the role of hyoscine for polyp detectionduring colonoscopy.METHODS: Studies(randomized controlled trials orRCTs) that compared the use of hyoscine vs no hyo-scine or placebo for polyp detection during colonoscopywere included in our analysis. A search on multiple da-tabases was performed in September 2013 with searchterms being "hyoscine and colonoscopy", "hyoscineand polyp", "hyoscine and adenoma", "antispasmoticand colonoscopy", "antispasmotic and adenoma", and"antispasmotic and polyp". Jadad scoring was used toassess the quality of studies. The efficacy of hyoscinewas analyzed using Mantel-Haenszel model for polypand adenoma detection with odds ratio(OR). The I2measure of inconsistency was used to assess hetero-geneity(P < 0.05 or I2 > 50%). Statistical analysis was performed by RevMan 5.1. Funnel plots was used to assess publication bias.RESULTS: The search of the electronic databases identified 283 articles. Of these articles, eight published RCTs performed at various locations in Europe, Asia, and Australia were included in our meta-analysis, seven published as manuscripts and one published as an ab-stract(n = 2307). All the studies included patients with a hyoscine and a no hyoscine/placebo group and were of adequate quality(Jadad score ≥ 2). Eight RCTs as-sessed the polyp detection rate(PDR)(n = 2307). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for PDR(OR = 1.06; 95%CI: 0.89-1.25; P = 0.51). Five RCTs assessed the adenoma detection rate(ADR)(n = 2015). The use of hyoscine demonstrated no statisti-cally significant difference as compared to no hyoscine or placebo for ADR(OR = 1.12; 95%CI: 0.92-1.37; P = 0.25). Furthermore, the timing of hyoscine admin-istration(given at cecal intubation or pre-procedure) demonstrated no differences in PDR compared to no hyoscine or placebo. Publication bias or heterogeneity was not observed for any of the outcomes.CONCLUSION: Hyoscine use in patients undergoing colonoscopy does not appear to significantly increase the detection of polyps or adenomas.

Is there a difference between 19G core biopsy needle and 22G core biopsy needle in diagnosing the correct etiology?——A meta-analysis and systematic review

AIM To compare the accuracy of endoscopic ultra-sonography(EUS) 19 G core biopsies and 22 G core biopsies in diagnosing the correct etiology for a solid mass.METHODS Articles were searched in Medline, Pub Med, and Ovid journals. Pooling was conducted by both fixed and random effects models. RESULTS Initial search identified 4460 reference articles for 19 G and 22 G, of these 670 relevant articles were selected and reviewed. Data was extracted from 6 studies for 19G(n = 289) and 16 studies for 22G(n = 592) which met the inclusion criteria. EUS 19 G core biopsies had a pooled sensitivity of 91.6%(95%CI: 87.1-95.0) and pooled specificity of 95.9%(95%CI: 88.6-99.2), whereas EUS 22 G had a pooled sensitivity of 83.3%(95%CI: 79.7-86.6) and pooled specificity of 64.3%(95%CI: 54.7-73.1). The positive likelihood ratio of EUS 19 G core biopsies was 9.08(95%CI: 1.12-73.66) and EUS 22 G core biopsies was 1.99(95%CI: 1.09-3.66).The negative likelihood ratio of EUS 19 G core biopsies was 0.12(95%CI: 0.07-0.24) and EUS 22 G core biopsies was 0.25(95%CI: 0.14-0.41). The diagnostic odds ratio was 84.74(95%CI: 18.31-392.26) for 19 G core biopsies and 10.55(95% CI: 3.29-33.87) for 22 G needles. CONCLUSION EUS 19 G core biopsies have an excellent diagnostic value and seem to be better than EUS 22 G biopsies in detecting the correct etiology for a solid mass.

Weekday vs weekend endoscopy: Is there a true difference in patient outcomes? A meta-analysis

AIM:To evaluate the"weekend effect"on outcomes in patient admitted on the weekend for upper gastrointestinal bleeding(UGIB).METHODS:A comprehensive search was performed(March 2014).Studies comparing weekend and weekday endoscopy in patients with UGIB were included.All studies had at least 2 of 3 primary outcomes which included:mortality,need for surgery,time to endoscopy,endoscopy on admission day,and length of hospital stay.Three authors individually extracted data.Metaanalysis was performed using pooled estimates with odds ratio or mean difference by fixed and random effects models.RESULTS:Eleven studies met the inclusion criteria.Patients admitted with UGIB on the weekend exhibited a statistically significant increase in mortality(OR=1.13;95%CI:1.06-1.20;P<0.01),need for surgery(OR=2.46;95%CI:1.51-3.99;P<0.01),and time to endoscopy(MD 2.68;95%CI:0.17-5.20;P=0.04)as compared to patients admitted with UGIB on a weekday.Furthermore,patients with UGIB admitted on weekend experienced statistically significant less endoscopy on day of admission(OR=0.72;95%CI:0.62-0.85;P<0.01).No difference was noted between the two groups for length of hospital stay(MD-1.29;95%CI:-3.03-0.45;P=0.15).CONCLUSION:A weekend effect seems to be apparent in patients with UGIB with significantly poorer outcomes.

Split-dose vs same-day bowel preparation for afternoon colonoscopies:A meta-analysis of randomized controlled trials

BACKGROUND Quality of bowel preparation in afternoon colonoscopies has been a struggle.Currently,a choice of same-day preparation(SaD)or split-dose preparation(SpD)exists;however,randomized controlled trials’results have varied.AIM To examine the outcomes of SaD and SpD for afternoon colonoscopies.METHODS An extensive literature search was conducted using multiple databases.Only randomized controlled trials(RCTs)in adults that compared SaD to SpD with Ottawa bowel preparation score(OBPS)were included.Odds ratio(OR)or mean difference was used to analyze outcomes.RESULTS Eleven RCTs were included(n=1846).No difference was observed for satisfactory bowel preparation based on OBPS among participants receiving SaD vs SpD(OR 0.77;95%CI:-0.57-1.03;P=0.07;I2=5%).Subgroup analysis showed no difference in terms of satisfactory bowel preparation based on OBPS between the two groups when receiving same preparation formula(polyethylene glycol)(OR 0.83;95%CI:0.51-1.35;P=0.46;I2=39%)as well as receiving same formula and volume(4 L polyethylene glycol)(OR 1.14;95%CI:0.65-2.01;P=0.64;I2=0%).CONCLUSION In patients undergoing afternoon colonoscopies,SaD is comparable with SpD in terms of satisfactory bowel preparation.Further studies are needed to validate these results and determine the optimal formula and dosages.

Ascorbic acid and low-volume polyethylene glycol for bowel preparation prior to colonoscopy:A meta-analysis

AIM: To evaluate the benefits of low-volume polyethylene glycol(PEG) with ascorbic acid compared to fulldose PEG for colonoscopy preparation. METHODS: MEDLINE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, CINAHL, Pub Med, and recent abstracts from major conferences were searched(January 2012). Only randomized-controlled trials on adult subjects comparing lowvolume PEG(2 L) with ascorbic acid vs full-dose PEG(3 or 4 L) were included. Meta-analysis for the efficacy of low-volume PEG with ascorbic acid and full-dose PEG were analyzed by calculating pooled estimates of number of satisfactory bowel preparations as well as adverse patient events(abdominal pain, nausea, vomiting). Separate analyses were performed for each main outcome by using OR with fixed and random effects models. Heterogeneity was assessed by calculating the I2 measure of inconsistency. Rev Man 5.1 was utilized for statistical analysis.RESULTS: The initial search identified 242 articles and trials. Nine studies(n = 2911) met the inclusion criteria and were analyzed for this meta-analysis with mean age range from 53.0 to 59.6 years. All studies were randomized controlled trials on adult patients comparing large-volume PEG solutions(3 or 4 L) with low-volume PEG solutions and ascorbic acid. No statistically significant difference was noted between lowvolume PEG with ascorbic acid and full-dose PEG for number of satisfactory bowel preparations(OR 1.07, 95%CI: 0.86-1.33, P = 0.56). No statistically significant difference was noted between low-volume PEG with ascorbic acid and full-dose PEG for abdominal pain(OR 1.09, 95%CI: 0.81-1.48, P = 0.56), nausea(OR 0.70, 95%CI: 0.49-1.00, P = 0.05), or vomiting(OR 0.99, 95%CI: 0.78-1.26, P = 0.95). No publication bias was noted.CONCLUSION: Low-volume PEG with the addition of ascorbic acid demonstrates no statistically significant difference to full-dose PEG for satisfactory bowel preparation and side-effects.

Use of music during colonoscopy:An updated meta-analysis of randomized controlled trials

BACKGROUND Music seems to be beneficial in multiple clinical areas.Colonoscopy is a stressful event for patients,especially with conscious sedation.Music during colonoscopy has been evaluated in multiple randomized controlled trials(RCTs)with varied results.Even meta-analyses on the subject over the years have yielded inconsistent conclusions.Therefore,we conducted an up-to-date meta-analysis regarding music during colonoscopy.AIM To assess the effects of music played during colonoscopy on patients’perspectives and sedation requirements.METHODS Multiple large databases were aggressively searched(November 2018).RCTs comparing music to without music during colonoscopy on adult patients were included.Pooled estimates were calculated for sedative medication doses,total procedure time,and patients’experience,willingness to repeat procedure,and pain scores using odds ratio(OR)and mean difference(MD)with random effects model.RESULTS Eleven studies(n=988)were included.Music during colonoscopy showed a statistically significant reduction in procedure times(MD:-2.3 min;95%CI:-4.13 to-0.47;P=0.01)and patients’pain(MD:-1.26;95%CI:-2.28 to-0.24;P=0.02)while improving patients’experience(MD:-1.11;95%CI:-1.7 to-0.53;P<0.01)as compared to no music.No statistically significant differences were observed between music and no music during colonoscopy for midazolam(MD:-0.4 mg;95%CI:-0.9 to 0.09;P=0.11),meperidine(MD:-3.06 mg;95%CI:-10.79 to 4.67;P=0.44),or patients’willingness to repeat the colonoscopy(OR:3.89;95%CI:0.76 to 19.97;P=0.1).CONCLUSION Music appears to improve overall patient experience while reducing procedure times and patient pain.Therefore,music,being a non-invasive intervention,should be strongly considered during colonoscopy.