Bowel preparation is a core issue in colonoscopy,as it is closely related to the quality of the procedure.Patients often find that bowel preparation is the most unpleasant part of the examination.It is widely accepted...Bowel preparation is a core issue in colonoscopy,as it is closely related to the quality of the procedure.Patients often find that bowel preparation is the most unpleasant part of the examination.It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions.In spite of its importance and potential implications,until recently,bowel preparation has not been the subject of much study.The most commonly used agents are high-volume polyethylene glycol(PEG)electrolyte solution and sodium phosphate.There has been some confusion,even in published meta-analyses,regarding which of the two agents provides better cleansing.It is clear now that both PEG and sodium phosphate are effectivewhen administered with proper timing.Consequently,the timing of administration is recognized as one of the central factors to the quality of cleansing.The bowel preparation agent should be administered,at least in part,a few hours in advance of the colonoscopy.Several low volume agents are available,and either new or modified schedules with PEG that usually improve tolerance.Certain adjuvants can also be used to reduce the volume of PEG,or to improve the efficacy of other agents.Other factors apart from the choice of agent can improve the quality of bowel cleansing.For instance,the effect of diet before colonoscopy has not been completely clarified,but an exclusively liquid diet is probably not required,and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure.Some patients,such as diabetics and persons with heart or kidney disease,require modified procedures and certain precautions.Bowel preparation for pediatric patients is also reviewed here.In such cases,PEG remains the most commonly used agent.As detecting neoplasia is not the main objective with these patients,less intensive preparation may suffice.Special considerations must be made for patients with inflammatory bowel disease,including safety and diagnostic issues,so that the most adequate agent is chosen.Identifying neoplasia is one of the main objectives of colonoscopy with these patients,and the target lesions are often almost invisible with white light endoscopy.Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy.Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge,and the strategies available are also reviewed here.展开更多
AIM:To prospectively confirm whether a small amount of polyethylene glycol(PEG)ingested after swallowing endoscopy capsule improves image quality and completion rate.METHODS:Forty-four consecutive patients referred to...AIM:To prospectively confirm whether a small amount of polyethylene glycol(PEG)ingested after swallowing endoscopy capsule improves image quality and completion rate.METHODS:Forty-four consecutive patients referred to us for capsule endoscopy(CE)were randomized to two groups.All patients were restricted to clear fluids for 12 h before the examination.Patients in group A(22 cases)received no additional preparation,while those in group B(20 cases)ingested 500 mL of PEG within a 2 h period starting 30 min after swallowing the capsule.Clear fluids and meals were allowed 2 h and 4 h after capsule ingestion,respectively.Image quality was assessed as the percentage of visualized bowel surface area as follows:1:<25%;2:25%-49%;3:50%-74%;4:75%-89%;5:>90%.The small bowel record was divided into five segments by time,and the score for each segment was evaluated.All CE examinations were performed with the Pillcam SB capsule endoscopy sys-tem(Given Imaging Co.Ltd.,Yoqnem).RESULTS:This study ended in December 2009,because sample size was considered large enough.A total of 44 patients were enrolled.Two patients in group B were excluded from the analysis because small bowel images could not be obtained from these patients;one had a full stomach,while the other presented with a massive gastric bleed.Thus,22 patients from group A and 20 patients from group B completed the study.There was no significant difference in age(P=0.22),sex(P=0.31),and indication for CE.No significant adverse events occurred in any of the study patients.In group A,image quality deteriorated as the capsule progressed distally.However,in group B,image quality was maintained to the distal small bowel.In each of the five segments,the visibility score was significantly higher in group B than in group A(segment 1:4.3± 0.7vs 4.7±0.5,P=0.03;segment 2:4.2±0.9vs 4.8 ±0.4,P=0.01;segment 3:4.0±1.0 vs 4.6±0.7,P =0.04;segment 4:3.6±1.1 vs 4.5±0.6,P=0.003;segment 5:2.7±1.0vs 4.4±0.8,P=0.00004).Thus,the use of PEG during CE examination significantly improved image quality in all time segments,and this effect was more pronounced in the distal ileum.The completion rate to the cecum was not significantly different between groups A and B(81.8%vs 85.0%,P =0.89).There was no difference in the gastric transit time between groups(36.2±35.0 min vs 54.0±56.6 min,P=0.23),but the small bowel transit time was significantly longer in group A than in group B(246.0± 107.0 minvs 171.0±104.0 min,P=0.04).CONCLUSION:The ingestion of a small amount of PEG after the swallowing of an endoscopy capsule significantly improved CE image quality,but did not enhance the completion rate to the cecum.展开更多
AIM:To clarify the clinicopathological characteristics of small and large early invasive colorectal cancers(EI-CRCs),and to determine whether malignancy grade depends on size.METHODS:A total of 583 consecutive EI-CRCs...AIM:To clarify the clinicopathological characteristics of small and large early invasive colorectal cancers(EI-CRCs),and to determine whether malignancy grade depends on size.METHODS:A total of 583 consecutive EI-CRCs treated by endoscopic mucosal resection or surgery at the National Cancer Center Hospital between 1980 and 2004 were enrolled in this study.Lesions were classified into two groups based on size:small(≤10mm) and large(>10mm).Clinicopathological features,incidence of lymph node metastasis(LNM) and risk factors for LNM,such as depth of invasion,lymphovascular invasion(LVI) and poorly differentiated adenocarcinoma(PDA) were analyzed in all resected specimens.RESULTS:There were 120(21%) small and 463(79%) large lesions.Histopathological analysis of the small lesion group revealed submucosal deep cancer(sm:≥1000 μm) in 90(75%) cases,LVI in 26(22%) cases,and PDA in 12(10%) cases.Similarly,the large lesion group exhibited submucosal deep cancer in 380(82%) cases,LVI in 125(27%) cases,and PDA in 79(17%) cases.The rate of LNM was 11.2% and 12.1% in the small and large lesion groups,respectively.CONCLUSION:Small EI-CRC demonstrated the same aggressiveness and malignant potential as large cancer.展开更多
文摘Bowel preparation is a core issue in colonoscopy,as it is closely related to the quality of the procedure.Patients often find that bowel preparation is the most unpleasant part of the examination.It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions.In spite of its importance and potential implications,until recently,bowel preparation has not been the subject of much study.The most commonly used agents are high-volume polyethylene glycol(PEG)electrolyte solution and sodium phosphate.There has been some confusion,even in published meta-analyses,regarding which of the two agents provides better cleansing.It is clear now that both PEG and sodium phosphate are effectivewhen administered with proper timing.Consequently,the timing of administration is recognized as one of the central factors to the quality of cleansing.The bowel preparation agent should be administered,at least in part,a few hours in advance of the colonoscopy.Several low volume agents are available,and either new or modified schedules with PEG that usually improve tolerance.Certain adjuvants can also be used to reduce the volume of PEG,or to improve the efficacy of other agents.Other factors apart from the choice of agent can improve the quality of bowel cleansing.For instance,the effect of diet before colonoscopy has not been completely clarified,but an exclusively liquid diet is probably not required,and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure.Some patients,such as diabetics and persons with heart or kidney disease,require modified procedures and certain precautions.Bowel preparation for pediatric patients is also reviewed here.In such cases,PEG remains the most commonly used agent.As detecting neoplasia is not the main objective with these patients,less intensive preparation may suffice.Special considerations must be made for patients with inflammatory bowel disease,including safety and diagnostic issues,so that the most adequate agent is chosen.Identifying neoplasia is one of the main objectives of colonoscopy with these patients,and the target lesions are often almost invisible with white light endoscopy.Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy.Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge,and the strategies available are also reviewed here.
文摘AIM:To prospectively confirm whether a small amount of polyethylene glycol(PEG)ingested after swallowing endoscopy capsule improves image quality and completion rate.METHODS:Forty-four consecutive patients referred to us for capsule endoscopy(CE)were randomized to two groups.All patients were restricted to clear fluids for 12 h before the examination.Patients in group A(22 cases)received no additional preparation,while those in group B(20 cases)ingested 500 mL of PEG within a 2 h period starting 30 min after swallowing the capsule.Clear fluids and meals were allowed 2 h and 4 h after capsule ingestion,respectively.Image quality was assessed as the percentage of visualized bowel surface area as follows:1:<25%;2:25%-49%;3:50%-74%;4:75%-89%;5:>90%.The small bowel record was divided into five segments by time,and the score for each segment was evaluated.All CE examinations were performed with the Pillcam SB capsule endoscopy sys-tem(Given Imaging Co.Ltd.,Yoqnem).RESULTS:This study ended in December 2009,because sample size was considered large enough.A total of 44 patients were enrolled.Two patients in group B were excluded from the analysis because small bowel images could not be obtained from these patients;one had a full stomach,while the other presented with a massive gastric bleed.Thus,22 patients from group A and 20 patients from group B completed the study.There was no significant difference in age(P=0.22),sex(P=0.31),and indication for CE.No significant adverse events occurred in any of the study patients.In group A,image quality deteriorated as the capsule progressed distally.However,in group B,image quality was maintained to the distal small bowel.In each of the five segments,the visibility score was significantly higher in group B than in group A(segment 1:4.3± 0.7vs 4.7±0.5,P=0.03;segment 2:4.2±0.9vs 4.8 ±0.4,P=0.01;segment 3:4.0±1.0 vs 4.6±0.7,P =0.04;segment 4:3.6±1.1 vs 4.5±0.6,P=0.003;segment 5:2.7±1.0vs 4.4±0.8,P=0.00004).Thus,the use of PEG during CE examination significantly improved image quality in all time segments,and this effect was more pronounced in the distal ileum.The completion rate to the cecum was not significantly different between groups A and B(81.8%vs 85.0%,P =0.89).There was no difference in the gastric transit time between groups(36.2±35.0 min vs 54.0±56.6 min,P=0.23),but the small bowel transit time was significantly longer in group A than in group B(246.0± 107.0 minvs 171.0±104.0 min,P=0.04).CONCLUSION:The ingestion of a small amount of PEG after the swallowing of an endoscopy capsule significantly improved CE image quality,but did not enhance the completion rate to the cecum.
文摘AIM:To clarify the clinicopathological characteristics of small and large early invasive colorectal cancers(EI-CRCs),and to determine whether malignancy grade depends on size.METHODS:A total of 583 consecutive EI-CRCs treated by endoscopic mucosal resection or surgery at the National Cancer Center Hospital between 1980 and 2004 were enrolled in this study.Lesions were classified into two groups based on size:small(≤10mm) and large(>10mm).Clinicopathological features,incidence of lymph node metastasis(LNM) and risk factors for LNM,such as depth of invasion,lymphovascular invasion(LVI) and poorly differentiated adenocarcinoma(PDA) were analyzed in all resected specimens.RESULTS:There were 120(21%) small and 463(79%) large lesions.Histopathological analysis of the small lesion group revealed submucosal deep cancer(sm:≥1000 μm) in 90(75%) cases,LVI in 26(22%) cases,and PDA in 12(10%) cases.Similarly,the large lesion group exhibited submucosal deep cancer in 380(82%) cases,LVI in 125(27%) cases,and PDA in 79(17%) cases.The rate of LNM was 11.2% and 12.1% in the small and large lesion groups,respectively.CONCLUSION:Small EI-CRC demonstrated the same aggressiveness and malignant potential as large cancer.
