Randomized controlled trial of sodium phosphate tablets vs polyethylene glycol solution for colonoscopy bowel cleansing

AIM:To compare efficacy,patient compliance,acceptability,satisfaction,safety,and adenoma detection rate of sodium phosphate tablets(NaP,CLICOLONTM)to a standard 4 L polyethylene glycol(PEG)solution for bowel cleansing for adults undergoing colonoscopy.METHODS:In this multicenter,randomized,prospective,investigator-blind study,the relatively young(19-60years)healthy outpatients without comorbidity were randomly assigned to one of two arms.All colonoscopy were scheduled in the morning.The NaP group was asked to take 4 tablets,5 times the evening before and4 tablets,3 times early on the morning of the colonoscopy.The PEG group was asked to ingest 2 L of solution the evening before and 2 L early in the morning of the procedure.Adequacy of bowel preparation was scored using the Boston bowel preparation scale.RESULTS:No significant differences were observed between the NaP group(n=158)and PEG group(n=162)in bowel cleansing quality(adequate preparation93.0%vs 92.6%,P=0.877),patient compliance(P=0.228),overall adverse events(63.3%vs 69.1%,P=0.269),or adenoma detection rate(34.8%vs 35.2%,P=0.944).Patient acceptability,satisfaction,and patient rating of taste were higher in the NaP group than in the PEG group(P<0.001).CONCLUSION:NaP tablets,compared with PEG solution,produced equivalent colon cleansing,did not cause more side effects,and had better patient acceptability and satisfaction in the relatively young(age<60years)healthy individuals without comorbidity.An oral tablet formulation could make bowel preparation less burdensome,resulting in greater patient participation in screening programs.

Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis

Hepatic artery pseudoaneurysm(HAP) is a very rare disease but in cases of complication,there is a very high mortality.The most common cause of HAP is iatrogenic trauma such as liver biopsy,transhepatic biliary drainage,cholecystectomy and hepatectomy.HAP may also occur with complications such as infections or inflammation associated with septic emboli.HAP has been reported rarely in patients with acute pancreatitis.As far as we are aware,there is no report of a case caused by acute idiopathic pancreatitis,particularly.We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman.The woman initially presented with acute pancreatitis due to unknown cause.After conservative management,her symptoms seemed to have improved.But eight days after admission,abdominal pain abruptly became worse again.Abdominal computed tomography(CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT.Endoscopic retrograde cholangiopancreatography(ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain.ERCP confirmed hemobilia by observing fresh blood clots at the opening of the ampulla and several filling defects in the distal common bile duct on cholangiogram.Without any particular treatment such as embolization or surgical ligation,HAP thrombosed spontaneously.Three months after discharge,abdominal CT demonstrated that HAP in the left lateral segment had disappeared.