Addition of castor oil as a booster in colon capsule regimens significantly improves completion rates and polyp detection

BACKGROUND Incomplete excretion rates are problematic for colon capsule endoscopy(CCE).Widely available booster regimens are suboptimal.Recently published data on one day preparation CCE protocol using castor oil appeared effective.AIM To assess the impact of adding castor oil to a standard split-dose(2-d)preparation in an unselected Western patient cohort.METHODS All patients aged 18 or more referred to our unit for a CCE over a 5-mo period were prospectively recruited.Controls were retrospectively identified from our CCE database.All patients received split bowel preparation with Moviprep■[polyethylene glycol(PEG)-3350,sodium sulphate,sodium chloride,potassium chloride,sodium ascorbate and ascorbic acid for oral solution;Norgine B.V,United States],a PEG-based solution used predominantly in our colonoscopy practice.Control booster regimen included Moviprep■with 750 mL of water(booster 1)on reaching the small bowel.A further dose of Moviprep■with 250 mL of water was given 3 h later and a bisacodyl suppository(Dulcolax■)10 mg after 8 h,if the capsule was not excreted.In addition to our standard booster regimen,cases received an additional 15 mL of castor oil given at the time of booster 1.A nested case control design with 2:1 ratio(control:case)was employed.Basic demographics,completion rates,image quality,colonic transit time,diagnostic yield and polyp detection were compared between groups,using a student t or chi-square tests as appropriate.RESULTS One hundred and eighty-six CCEs[mean age 60 years(18-97),56%females,n=104],including 62 cases have been analysed.Indication breakdown included 96 polyp surveillance(51.6%),42 lower gastrointestinal symptoms(22.6%),28 due to incomplete colonoscopy(15%),18 anaemia(9.7%)and 2 inflammatory bowel disease surveillance(1.1%).Overall,CCE completion was 77%(144/186),image quality was adequate/diagnostic in 91%(170/186),mean colonic transit time was 3.5 h(0.25-13),and the polyp detection rate was 57%(106/186).Completion rates were significantly higher with castor oil,87%cases(54/62)vs 73%controls(90/124),P=0.01.The number needed to treat with castor oil to result in an additional complete CCE study was 7,absolute risk reduction=14.52%,95%confidence interval(CI):3.06-25.97.This effect of castor oil on excretion rates was more significant in the over 60 s,P<0.03,and in females,P<0.025.Similarly,polyp detection rates were higher in cases 82%(51/62)vs controls 44%(55/124),P=0.0001,odds ratio 5.8,95%CI:2.77-12.21.Colonic transit times were similar,3.2 h and 3.8 h,respectively.Image quality was similar,reported as adequate/diagnostic in 90%(56/62)vs 92%(114/124).CONCLUSION In our capsule endoscopy centre,castor oil addition as a CCE booster significantly improved completion rates and polyp detection in an unselected Western cohort.

Effect of quality of bowel preparation on quality indicators of adenoma detection rates and colonoscopy completion rates

Background and aim:Adequate bowel preparation is important for safe and effective colonoscopy.Quality indicators(QI)for colonoscopy include achieving at least 95%completion rate and an adenoma detection rate(ADR)of at least 25%in average-risk men and 15%in average-risk women aged over 50.Our aim was to investigate the impact of bowel preparation on ADR and colonoscopy completion rates.Methods:This retrospective cohort study included patients who underwent colonoscopy between January 2008 and December 2009.The main outcome measurements were ADR and colonoscopy completion rates to the cecum.Results:A total of 2519 patients was included;1030(41.0%)had excellent preparation,1145(45.5%)good-,240(9.5%)fair-,and 104(4.1%)poor preparation.Colonoscopy completion rates were significantly lower in patients with poor or fair preparation(72.1%and 75.4%,respectively)than in those with good and excellent preparation(99.7%and 99.9%,respectively;P<0.001),and significantly lower than the QI of 95%(P<0.001).ADR in men and women combined was similar in all four grades of preparation(excellent,good,fair and poor)at 24.2%vs.26.8%vs.32.1%vs.22.1%,respectively;P¼0.06.All the groups had ADR above the QI(25%for men and 15%for women)with evidence of significantly higher ADR in the women with excellent or good preparation and in men with excellent,good or fair preparation.On multivariate analysis,male gender was significantly associated with increased ADR(P<0.001),while the quality of bowel preparation did not influence ADR.Conclusions:Patients with fair and poor standards of preparation have significantly lower colonoscopy completion rates than those with excellent and good preparation.However,there was no difference in ADR between the different grades of preparation.

Colorectal cancer fecal screening test completion after age 74,sources and outcomes in French program

BACKGROUND Elderly patients aged at least 75 years old(Elderly_75),represent 45%of colorectal cancer(CRC)incidence.As others,the French Colorectal Cancer Screening Program(CRCSP)does not include Elderly_75.To date,there is little evidence to justify stopping screening at 74 years of age.AIM To describe CRC fecal screening test completion after age 74,source(CRCSP/Provider ordered)and outcomes of these tests.METHODS The study concerned 18704 Elderly_75 residing in eleven French districts(Ain,Doubs,Essonne,Haute-Saone,Hauts-de-Seine,Jura,Seine-Saint-Denis,Territoire-de-Belfort,Val-de-Marne,Val-d'Oise,Yonne),having performed a CRC screening test between January 2008 and December 2017.The tests performed in a circumstance of delayed response to a solicitation(DRS)from the local cancer screening managing center(Managing-Center)were distinguished from the tests non-solicited by the Managing-Center,performed after a recommendation by a General Practitioner(GP)or other provider ordered(RGP).DRS was any test realized by an Elderly_75 following an initial invitation from the ManagingCenter with a maximum 24 mo after this invitation.Any Non-DRS test was considered RGP.The outcomes of these tests were described according to the circumstances of test completion.RESULTS Of 18995 screening-tests were performed at ages:75(83.5%),76-80(13.4%)and>80(3.1%)years old.Elderly_75 performed the screening test in a circumstance of DRS(71.9%)or RGP(28.1%).The proportion of the tests that could not be analyzed and not restarted was 13.2%.For these unanalyzed tests,the reason was age-related in 78.0%of cases,related to the laboratory's refusal to analyze the test of people aged≥77.Reported colonoscopy completion rate was 81.3%.For those575 people with reported colonoscopy,no complication was listed.18.0%of the366 Elderly_75 with lesions had no anteriority in the CRCSP.The neoplasia(124 Low-risk-polyps,159 High-risk-polyps,13 Unspecified-polyps and 70 CRCs)detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was3.7/1000 Elderly_75 screened.CONCLUSION The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.

Endoscopic mucosal resection with double band ligation versus endoscopic submucosal dissection for small rectal neuroendocrine tumors

BACKGROUND Endoscopic resection remains an effective method for the treatment of small rectal neuroendocrine tumors(NETs)(≤10 mm).Moreover,endoscopic mucosal resection(EMR)with double band ligation(EMR-dB),a simplified modification of EMR with band ligation,is an alternative strategy to remove small rectal NETs.AIM To evaluate the feasibility and safety of EMR-dB for the treatment of small rectal NETs(≤10 mm).METHODS A total of 50 patients with small rectal NETs,without regional lymph node enlargement or distant metastasis confirmed by endoscopic ultrasound,computerized tomography scan,or magnetic resonance imaging,were enrolled in the study from March 2021 to June 2022.These patients were randomly assigned into the EMR-dB(n=25)group or endoscopic submucosal dissection(ESD)group(n=25).The characteristics of the patients and tumors,procedure time,devices cost,complete resection rate,complications,and recurrence outcomes were analyzed.RESULTS There were 25 patients(13 males,12 females;age range 28-68 years old)in the EMR-dB group,and the ESD group contained 25 patients(15 males,10 females;age range 25-70 years old).Both groups had similar lesion sizes(EMR-dB 4.53±1.02 mm,ESD 5.140±1.74 mm;P=0.141)and resected lesion sizes(1.32±0.52 cm vs 1.58±0.84 cm;P=0.269).Furthermore,the histological complete resection and en bloc resection rates were achieved in all patients(100%for each).In addition,there was no significant difference in the complication rate between the two groups.However,the procedure time was significantly shorter and the devices cost was significantly lower in the EMRdB group.Besides,there was no recurrence in both groups during the follow-up period.CONCLUSION The procedure time of EMR-dB was shorter compared with ESD,and both approaches showed a similar curative effect.Taken together,EMR-dB was a feasible and safe option for the treatment of small rectal NETs.

Effect of Rituximab Versus Mycophenolate Mofetil or Cyclophosphamide as Control in Lupus Nephritis:A Meta-Analysis

Objective:To evaluate the effects of rituximab versus mycophenolate mofetil or cyclophosphamide as control in lupus nephritis by meta-analysis.Methods:A systematic search was carried out up to January 2022,obtaining 7 studies involving 645 participants with lupus nephritis at the commencement of the investigation;198 of them were treated with rituximab,while 447 were treated with mycophenolate mofetil or cyclophosphamide.We determined the odds ratio(OR)and mean difference(MD)with 95%confidence index(CI)to compare rituximab’s efficacy to that of mycophenolate mofetil or cyclophosphamide as control in lupus nephritis using random-or fixed-effects model by dichotomous or continuous techniques.Results:The rituximab group showed significantly higher complete renal remission rate(OR=2.52;95%CI 1.30-4.91,P=0.006)and total renal remission rates(OR=2.22;95%CI 1.36-3.63,P=0.001)than the control group.However,there was no significant difference in terms of end Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score(MD-1.16;95%CI-2.88-0.57,P=0.19),proteinuria(MD-0.31;95%CI-0.70-0.09,P=0.013),and serum creatinine(MD 0.01;95%CI-0.04-0.07,P=0.64)between the rituximab group and the control.Conclusion:Rituximab exhibited significantly greater complete renal remission rate and total renal remission rates,with no significant difference in terms of shorter-end SLEDAI,proteinuria,and serum creatinine,compared with the control in individuals with lupus nephritis.

Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations

AIM： To examine the predictive factors of capsule en- doscopy （CE） completion rate （CECR） including the ef- fect of inpatient and outpatient status.METHODS： We identified 355 consecutive patients who completed CE at Rush University Medical Center between March 2003 and October 2005. Subjects for CE had either nothing by mouth or clear liquids for the afternoon and evening of the day before the pro- cedure. CE exams were reviewed by two physicians who were unaware of the study hypotheses. After retrospective analysis, 21 cases were excluded due to capsule malfunction, prior gastric surgery, endoscopic capsule placement or insufficient data. Of the remain- ing 334 exams [264 out-patient （OP）, 70 in-patient （IP）], CE indications, findings, location of the patients [IP vs OP and intensive care unit （ICU） vs general medical floor （GMF）] and gastrointestinal transit times were analyzed. Statistical analysis was completed us- ing SPSS version 17 （Chicago, IL）. Chi-square, t test or fisher exact-tests were used as appropriate. Multivari- ate logistic regression analysis was used to identify variables associated with incomplete CE exams. RESULTS： The mean age for the entire study popula- tion was 54.7 years. Sixty-one percent of the study population was female, and gender was not different between IPs vs OPs （P = 0.07）. The overall incomplete CECR was 14% in our study. Overt obscure gastroin- testinal bleeding （OGB） was significantly more com- mon for the IP CE （P = 0.0001）, while abdominal pain and assessment of IBD were more frequent indications for the OP CE exams （P = 0.002 and P = 0.01, respec- tively）. Occult OGB was the most common indication and arteriovenous malformations were the most com- mon finding both in the IPs and OPs. The capsule did not enter the small bowel （SB） in 6/70 IPs and 8/264 OPs （P = 0.04）. The capsule never reached the cecum in 31.4% （22/70） of IP vs 9.5% （25/ 264） of OP ex- aminations （P 〈 0.001）. The mean gastric transit time （GTT） was delayed in IPs compared to OPs, 98.5 ± 139.5 min vs 60.4 ± 92.6 min （P = 0.008）. Minimal SB transit time was significantly prolonged in the IP com- pared to the OP setting [IP = 275.1±111.6 min vs OP = 244.0 ± 104.3 min （P = 0.037）]. CECR was also sig- nificantly higher in the subgroup of patients with OGB who had OP vs IP exams （95% vs 80% respectively, P = 0.001）. The proportion of patients with incomplete exams was higher in the ICU （n = 7/13, 54%） as com- pared to the GMF （n = 15/57, 26%） （P = 0.05）. There was only a single permanent SB retention case which was secondary to a previously unknown SB stricture, and the remaining incomplete SB exams were due to slow transit. Medications which affect gastrointesti- nal system motility were tested both individually and also in aggregate in univariate analysis in hospitalized patients （ICU and GMF） and were not predictive of incomplete capsule passage （P 〉 0.05）. Patient loca- tion （IP vs OP） and GTT were independent predictors of incomplete CE exams （P 〈 0.001 and P = 0.008, respectively）. CONCLUSION： Incomplete CE is a multifactorial prob- lem. Patient location and related factors such as sever- ity of illness and sedentary status may contribute to incomplete exams.

Prospective controlled study on the effects of polyethylene glycol in capsule endoscopy

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.

First-week clinical responses to dexlansoprazole 60 mg and esomeprazole 40 mg for the treatment of grades A and B gastroesophageal reflux disease

AIM To compare the one-week clinical effects of single doses of dexlansoprazole and esomeprazole on grades A and B erosive esophagitis.METHODS We enrolled 175 adult patients with gastroesophageal reflux disease(GERD). The patients were randomized in a 1:1 ratio into two sequence groups to define the order in which they received single doses of dexlansoprazole(n = 88) and esomeprazole(n = 87) for an intention-to-treat analysis. The primary endpoints were the complete symptom resolution(CSR) rates at days 1, 3, and 7 after drug administration.RESULTS Thirteen patients were lost to follow-up, resulting in 81 patients in each group for the per-protocol analysis. The CSRs for both groups were similar at days 1, 3 and 7. In the subgroup analysis, the female patients achieved higher CSRs in the dexlansoprazole group than in the esomeprazole group at day 3(38.3% vs 18.4%, P = 0.046). An increasing trend toward a higher CSR was observed in the dexlansoprazole group at day 7(55.3% vs 36.8%, P = 0.09). In the esomeprazole group, female sex was a negative predictive factor for CSR on post-administration day 1 [OR =-1.249 ± 0.543; 95%CI: 0.287(0.099-0.832), P = 0.022] and day 3 [OR =-1.254 ± 0.519; 95%CI: 0.285(0.103-0.789), P = 0.016]. Patients with spicy food eating habits achieved lower CSRs on day 1 [37.3% vs 21.4%, OR =-0.969 ± 0.438; 95%CI: 0.380(0.161-0.896), P = 0.027]. CONCLUSION The overall CSR for GERD patients was similar at days 1-7 for both the dexlansoprazole and esomeprazole groups, although a higher incidence of CSR was observed on day 3 in female patients who received a single dose of dexlansoprazole.

Effect of cold snare polypectomy for small colorectal polyps

BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer.The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically.Therefore,more attention has been paid to the development of endoscopic resection of intestinal polyps.In this study,we compared the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP).AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.METHODS Between January and December 2020,301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital,and were divided into the CSP group(n=154)and HSP group(n=147).The operating time,incidence of bleeding and perforation,use of titanium clips,and complete resection rate were compared between the two groups.RESULTS We included 249 patients(301 polyps).No differences in gender,age,and polyp size,location,shape and type were observed between the CSP and HSP groups,and the resection rates in these two groups were 93.4%and 94.5%,respectively,with no significant difference.The use of titanium clips was 15.6%and 95.9%,the operating time was 3.2±0.5 min and 5.6±0.8 min,the delayed bleeding rate was 0%and 2.0%,and delayed perforation was 0%and 0.7%,in the CSP and HSP groups,respectively.CONCLUSIONFor sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrityas traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe andeffective method for polypectomy.

The k Nearest Neighbors Estimator of the M-Regression in Functional Statistics

It is well known that the nonparametric estimation of the regression function is highly sensitive to the presence of even a small proportion of outliers in the data.To solve the problem of typical observations when the covariates of the nonparametric component are functional,the robust estimates for the regression parameter and regression operator are introduced.The main propose of the paper is to consider data-driven methods of selecting the number of neighbors in order to make the proposed processes fully automatic.We use thek Nearest Neighbors procedure(kNN)to construct the kernel estimator of the proposed robust model.Under some regularity conditions,we state consistency results for kNN functional estimators,which are uniform in the number of neighbors(UINN).Furthermore,a simulation study and an empirical application to a real data analysis of octane gasoline predictions are carried out to illustrate the higher predictive performances and the usefulness of the kNN approach.

Impact of Real-Time Contrast-Enhanced Ultrasound-Guided Radiofrequency Ablation on Progression-Free Survival in Patients with Hepatocellular Carcinoma:a Retrospective Case-Control Study

Objective To compare the value of contrast-enhanced ultrasound(CEUS)and conventional ultrasound(US)during radiofrequency ablation(RFA)for the treatment of hepatocellular carcinoma(HCC)≥3.0 cm in diameter.Methods A total of 149 HCC patients treated with RFA guided by either CEUS or conventional US between January 2012 and June 2013 were retrospectively analyzed.Patients were divided into different groups based on the type of ultrasound guidance(CEUS or conventional US)and tumor volume(diameter<3.0 or≥3.0 cm).The progressionfree survival(PFS)and complete ablation rates were compared between groups,and risk factors for the PFS were investigated.Results Seventy four patients received CEUS-guided RFA,and conventional US was performed in 75 patients.Among patients with a tumor<3.0 cm,the PFS and complete ablation rates were similar.However,for patients with a tumor≥3.0 cm,those treated with CEUS had a significantly longer PFS(17.3 vs.3.1 months,HR=2.73;95%CI,1.28~5.81;P=0.007)and higher complete ablation rates at 6-and 12-month post-treatment(87.5%vs.57.7%,P=0.042;75.0%vs.38.5%,P=0.009,respectively)than those treated with conventional US-guided RFA.The type of treatment(P=0.024)and maximum tumour size(P=0.011)were both found to be independent factors associated with the PFS.Conclusion Compared with conventional US,CEUS is more effective for guiding RFA in patients with HCC≥3.0 cm.CEUS-guided RFA could target HCC more accurately,and its ability to immediately detect any residual tumor during RFA might contribute to an increase in complete ablation rates and reduced progression.

An aggregate flow based scheduler in multi-task cooperated UAVs network

Unmanned Aerial Vehicles(UAVs)cooperative multi-task system has become the research focus in recent years.However,the existing network frameworks of UAVs are not flexible and efficient enough to deal with the complex multi-task scheduling,because they are not able to perceive the different features.In this paper,a novel cooperated UAVs network framework for multi-task scheduling is proposed.It is a three-layer network including a core layer,an aggregation layer and an execution layer,which enhances the efficiency of multi-task distribution,aggregation and transmission.Furthermore,an Aggre Gate Flow(AGFlow)based scheduler is dedicatedly designed to maximize the task completion rate,whose key point is to aggregate flows belonging to one task during the multi-task transmission of UAVs network and to allocate priority by calculating the urgency-level of each AGFlow.Simulation results demonstrate that,compared with that of state-of-the-art scheduler,the average task completion rate of AGFlow based scheduler is raised by 0.278.