Magnesium citrate with a single dose of sodium phosphate for colonoscopy bowel preparation

AIM:To evaluate the efficacy and acceptability of magnesium citrate and a single dose of oral sodium phosphate(45 mL) solution for morning colonoscopy bowel preparation. METHODS:A total of 159 patients were randomly assigned to receive two split doses of 90 mg of sodium phosphate(GroupⅠ,n=79) or magnesium citrate(250 mL,the day before the procedure) followed by 45 mL of sodium phosphate(the day of procedure,GroupⅡ,n= 80) .The quality of bowel cleansing and the acceptability of each regimen were compared,including the satisfaction,taste,willing to repeat and adverse effects of each regimen. RESULTS:The quality of bowel cleansing of GroupⅡ was as good as that of GroupⅠ(An Aronchick scale score of good or excellent:70.9%vs 81.0%,respectively,P=0.34;the Ottawa system score:4.4±2.6 vs 3.8 ±3.0,respectively,P=0.76) .There was no statisticallysignificant difference between both groups with regard to acceptability,including the satisfaction,taste and willingness to repeat the regimen.A significantly greater number of older patients(over 65 years old) in Group Ⅱgraded the overall satisfaction as satisfactory(48.1% vs 78.1%,respectively;GroupⅠvs GroupⅡ,P=0.01) . There were no significant adverse reactions. CONCLUSION:Magnesium citrate and a single dose of sodium phosphate was as effective and tolerable as the conventional sodium phosphate regimen and is a satisfactory option.

Clinical impact of atypical endoscopic features in rectal neuroendocrine tumors

AIM: To validate the association between atypical endoscopic features and lymph node metastasis(LNM).METHODS: A total of 247 patients with rectal neuroendocrine tumors(NETs) were analyzed. Endoscopic images were reviewed independently by two endoscopists, each of whom classified tumors by sized and endoscopic features, such as shape, color, and surface change(kappa coefficient 0.76 for inter-observer agreement). All of patients underwent computed tomography scans of abdomen and pelvis for evaluation of LNM. Univariate and multivariate analyses were performed to identify the factors associated with LNM. Additionally, the association between endoscopic atypical features and immunohistochemical staining of tumors was analyzed.RESULTS: Of 247 patients, 156(63.2%) were male and 15(6.1%) were showed positive for LNM. On univariate analysis, tumor size(P < 0.001), shape(P < 0.001), color(P < 0.001) and surface changes(P < 0.001) were significantly associated with LNM. On multivariate analysis, tumor size(OR = 11.53, 95%CI: 2.51-52.93, P = 0.002) and atypical surface(OR = 27.44, 95%CI: 5.96-126.34, P < 0.001) changes were independent risk factors for LNM. The likelihood of atypical endoscopic features increased as tumor size increased. Atypical endoscopic features were associated with LNM in rectal NETs < 10 mm(P = 0.005) and 10-19 mm(P = 0.041) in diameter. Immunohistochemical staining showed that the rate of atypical endoscopic features was higher in non L-cell tumors.CONCLUSION: Atypical endoscopic features as well as tumor size are predictive factors of LNM in patients with rectal NETs.