Bisacodyl plus split 2-L polyethylene glycol-citrate-simethicone improves quality of bowel preparation before screening colonoscopy

AIM:To compare the bowel cleansing efficacy,tolerability and acceptability of split 2-L polyethylene glycol(PEG)-citrate-simethicone(PEG-CS)plus bisacodyl(BIS)vs 4-L PEG for fecal occult blood test-positive screening colonoscopy.METHODS:This was a randomised,observer-blind comparative study.Two hundred and sixty-four subjects underwent screening colonoscopy(mean age 62.5±7.4years,male 61.7%).The primary objective of the study was to compare the bowel cleansing efficacy of the two preparations.Interventions:BIS plus PEG-CS:3 tablets of 5-mg BIS at 16:00,PEG-CS 1-L at 19:00 and 1-L at7:00,4-L PEG:3-L at 17:00,and 1-L at 7:00.Colonoscopy was carried out after 11:00,at least 3 h after the completion of bowel preparation.Bowel cleansing was evaluated using the Harefield Cleansing Scale.RESULTS:Bowel preparation was successful for 92.8%of subjects in the PEG-CS group and for 92.1%of subjects in the 4-L PEG(RR=1.01;95%CI:0.94-1.08).BIS+PEG-CS was better tolerated than 4-L PEG.A greater rate of patients in the BIS+PEG-CS group had no difficulty and/or were willing to repeat the same preparation compared to split-dose 4-L PEG group.Subjects in the BIS+PEG-CS group rated the prep as good or satisfactory in 90.6%as compared to 77%in the 4-L PEG(P=0.003).Subjects receiving BIS+PEGCS stated they fully adhered to instructions drinking all the 2-L solution in 97.1%compared with 87.3%in the4-L PEG(P=0.003).CONCLUSION:BIS plus split 2-L PEG-CS was as effective as but better tolerated and accepted than split4-L PEG for screening colonoscopy.This new procedure may increase the positive attitude and participation to colorectal cancer screening colonoscopy.

Systemic therapies for hepatocellular carcinoma: arecap of the current status

After decades of frustrating nihilism due to lack of innovative therapeutic solutions, the onco-hepatological community is facing up to important novelties for the treatment of intermediate and advanced stages of liver cancer. Four new drugs have been investigated and resulted in positive data: lenvatinib resulted not inferior to the standard of care sorafenib in first line, regorafenib and cabozantinib demonstrated prolonging survival in patients progressed to sorafenib and nivolumab approved by FDA as option after first-line. Contemporary, the knowledge acquired after ten years' experience of sorafenib in patient selection and adverse events management revealed an increase of the outcomes. Physicians dedicated to treat advanced and intermediated liver cancer are close to live a new era where systemic treatments could have a huge impact on the disease. The aim of this review is to anticipate this new approach at the disease, summarizing data currently available for these therapies to identify therapeutic strategies of sequences and choosing drugs according to the patient profile.