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.

Different risk factors for advanced colorectal neoplasm in young adults

AIM: To compare the risk of developing advanced colorectal neoplasm(ACRN) according to age in Koreans.METHODS: A total of 70428 Koreans from an occupational cohort who underwent a colonoscopy between 2003 and 2012 at Kangbuk Samsung Hospital were retrospectively selected. We evaluated and compared odds ratios(OR) for ACRN between the young-adults(YA < 50 years) and in the older-adults(OA ≥ 50 years). ACRN was defined as an adenoma ≥ 10 mm in diameter, adenoma with any component of villous histology, high-grade dysplasia, or invasive cancer.RESULTS: In the YA group, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 1.26, 95%CI: 1.02-1.55), current smoking(OR = 1.37, 95%CI: 1.15-1.63), family history of colorectal cancer(OR = 1.46, 95%CI: 1.01-2.10), diabetes mellitus related factors(OR = 1.27, 95%CI: 1.06-1.54), obesity(OR = 1.23, 95%CI: 1.03-1.47), CEA(OR = 1.04, 95%CI: 1.01-1.09) and low-density lipoprotein-cholesterol(OR = 1.01, 95%CI: 1.01-1.02) were related with an increased risk of ACRN. However, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 2.12, 95%CI: 1.68-2.68), current smoking(OR = 1.38, 95%CI: 1.12-1.71), obesity(OR = 1.34, 95%CI: 1.09-1.65) and CEA(OR = 1.05, 95%CI: 1.01-1.09) also increased the risk of ACRN in the OA group.CONCLUSION: The risks of ACRN differed based on age group. Different colonoscopic screening strategies are appropriate for particular subjects with risk factors for ACRN, even in subjects younger than 50 years.

Clinical outcomes and predictive factors in oral corticosteroid-refractory active ulcerative colitis

AIM:To evaluate the clinical outcomes and prognostic factors after intravenous corticosteroids following oral corticosteroid failure in active ulcerative colitis patients.METHODS:Consecutive patients with moderate to severe ulcerative colitis who had been treated with a course of intravenous corticosteroids after oral corticosteroid therapy failure between January 1996 and July 2010 were recruited at Severance Hospital,Seoul,South Korea.The disease activity was measured by the Mayo score,which consists of stool frequency,rectal bleeding,mucosal appearance at flexible sigmoidoscopy,and Physician Global Assessment.We retrospectively evaluated clinical outcomes at two weeks,one month,three months,and one year after the initiation of intravenous corticosteroid therapy.Two weeks outcomes were classified as responders or non-responders.One month,three month and one year outcomes were classified into prolonged response,steroid dependency,and refractoriness.RESULTS:Our study included a total of 67 eligible patients.At two weeks,56(83.6%) patients responded to intravenous corticosteroids.At one month,complete remission was documented in 18(32.1%) patients and partial remission in 26(46.4%).Eleven patients(19.7%) were refractory to the treatment.At three months and one year,we found 37(67.3%) and 25(46.3%) patients in prolonged response,ten(18.2%) and 23(42.6%) patients in corticosteroid dependency,8(14.5%) and 6(11.1%) patients with no response,respectively.Total 9 patients were underwent elective proctocolectomy within 1 year.The duration of oral corticosteroid therapy(> 14 d vs ≤ 14 d,P = 0.049) and lower hemoglobin level(≤ 11.0 mg/dL vs >11.0 mg/dL,P = 0.02) were found to be poor prognostic factors for response at two weeks.For one year outcome,univariate analysis revealed that only a partial Mayo score(≥ 6 vs <6,P = 0.057) was found to be associated with a poor response.CONCLUSION:The duration of oral corticosteroid therapy and lower hemoglobin level were strongly associated with poor outcome.