This meta-analysis compared the efficacy and tolerability of same-day (SaD) versus split-dose (SpD) bowel preparation regimens for colonoscopy. Fourteen randomized controlled trials with over 4,000 participants were included. The analysis found that the proportion of adequate bowel preparation was comparable between SaD and SpD regimens. SaD with bisacodyl was found to have higher odds of adequate preparation than SpD without bisacodyl. SaD also resulted in better sleep quality than SpD. However, overall rates of optimal preparation remained low for both regimens due to heterogeneous protocols. Further research is still needed to determine optimal purgative agents and dosing.
This guideline discusses the appropriate use of endoscopy in evaluating patients with dyspepsia. It recommends that patients over 50 years old or those with alarm features should undergo endoscopy due to their higher risk of structural diseases like cancer or peptic ulcers. Younger patients without alarm features may initially receive noninvasive testing for H. pylori infection and be treated if positive, or try acid suppression therapy. If these approaches do not resolve symptoms, endoscopy is recommended to check for structural causes. The guideline aims to help clinicians determine which dyspepsia patients most need endoscopy versus other initial treatment strategies.
Factors associated with developing esophageal adenocarcinoma in Barett's esop...Dr Sayan Das
Based on the study “Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett’s esophagus cohort” by Krishnamoorthi R et al published in “HHS Public Access” on 2016 July
A randomized, multicenter, placebo controlled trial of polyethylene glycol la...Duwan Arismendy
OBJECTIVES:
Polyethylene glycol (PEG) 3350 (MiraLAX) is currently approved for the short-term treatment of occasional constipation. This study was designed to compare the safety and efficacy of PEG laxative versus placebo over a 6-month treatment period in patients with chronic constipation.
METHODS:
Study subjects who met defined criteria for chronic constipation were randomized in this double-blind, placebo-controlled, parallel, multicenter study to receive PEG laxative as a single daily dose of 17 g or placebo for 6 months. Baseline constipation status was confirmed during a 14-day observation period. As a primary efficacy variable, treatment success was defined as relief of modified ROME criteria for constipation for 50% or more of their treatment weeks. Various secondary measures were assessed. An Interactive Voice Response System (IVRS) recorded daily bowel movement experience and study efficacy and safety information. Laboratory testing at baseline and monthly for the study duration was analyzed for hematology, blood chemistry including amylase, GGT, uric acid, lipids, and urinalysis.
RESULTS:
A total of 304 patients were enrolled and received treatment at one of 50 centers. Successful treatment according to the primary efficacy variable was seen in 52.0% of PEG and 11% of placebo subjects (P < 0.001). Similar efficacy was seen in a subgroup of 75 elderly subjects. According to the primary efficacy definition (based on individual treatment weeks), 61% of PEG treatment weeks versus 22% of the placebo weeks were successful (P < 0.001). There were no significant differences in laboratory findings or adverse events except for the gastrointestinal category where diarrhea, flatulence, and nausea were the most frequent with PEG although they were not individually statistically significant compared with placebo. Similar results were observed when analyzed for differences due to gender, race, or age.
Effect of Jianpi-yangwei decoction on gut fungi in the patients with gastric ...LucyPi1
Abstract Background: Our previous study shows that the empirical formula of Chinese medicine Jianpi-yangwei decoction (JYD) can improve the quality of life in patients with gastric cancer undergoing chemotherapy by increasing beneficial gut bacteria and decreasing harmful bacteria. The present study aims to investigate the effect of JYD on gut fungi in patients with gastric cancer undergoing chemotherapy. Methods: A total of 73 patients with gastric cancer undergoing chemotherapy were recruited. Twenty-nine patients in the chemotherapy group were given standard chemotherapy and 44 patients in the observation group were given JYD plus standard chemotherapy. A control group (55 cases) was recruited from the healthy medical examiners. After 3 months of treatment, life-quality score was evaluated and fecal microbiota was tested by high-throughput sequencing based on the 18S rRNA gene. Results: After treatment, life-quality score in the observation group was significantly lower than that in the chemotherapy group (P < 0.05). There was no significant difference between the observation and control groups’ diversity and richness indices of intestinal fungi. The Chao index for intestinal fungi in the chemotherapy group was significantly lower than that in the observation group (P < 0.05). There was a significant difference between the control and chemotherapy groups in the intestinal fungi according to Shannon and Simpson indices (P < 0.05). Linear discriminant analysis effect size analysis showed no significant differences among the three groups, but significant difference in intestinal fungi was observed between the observation group and the chemotherapy group. At the genus level, the relative abundance of the Aspergillus genus in the observation and control groups was significantly lower (P < 0.05), the relative abundance of the Cutaneotrichosporon, Galactomyces, and Ganoderma genus taxa was significantly higher compared with those in the chemotherapy group (P < 0.05), and there was no significant difference between the observation group and control group. Conclusion: JYD can ameliorate chemotherapy-induced fungal dysbacteriosis in patients with gastric cancer undergoing chemotherapy and improve the quality of life of patients.
This document contains summaries of multiple studies related to value-based healthcare for inflammatory bowel diseases. The first study found that a coordinated care program for IBD patients led to less corticosteroid use, more immunomodulator and biologic use, fewer hospitalizations and ER visits, and more biomarker testing compared to matched controls. The second study quantified patients' preferences for disease control, quality of life, and productivity outcomes using a choice-based survey. The third study evaluated a value-based healthcare program for IBD and found less corticosteroid use and trends toward more appropriate medication use and decreased utilization compared to matched controls.
Mc clave et_al-2016-journal_of_parenteral_and_enteral_nutritionAdiel Ojeda
This document provides guidelines for nutrition support therapy in adult critically ill patients from the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and the Society of Critical Care Medicine (SCCM). It summarizes the methodology used to develop the guidelines, which included compiling clinical questions, performing literature searches, and using the GRADE system to evaluate evidence and develop recommendations. The target population is adult critically ill patients expected to have an ICU stay greater than 2-3 days. Nutrition therapy is defined as the provision of enteral or parenteral nutrition, while standard therapy refers to IV fluids and advancement to oral diet as tolerated.
Combined use of AFP, CEA, CA125 and CAl9-9 improves the sensitivity for the d...Enrique Moreno Gonzalez
The detection of serum tumor marker becomes a common method for screening tumors. However,
this method has not been widely used for routine gastric cancer screening. In this study we aimed to determine
whether the combined use of tumor markers may increase the sensitivity for the diagnosis of gastric cancer.
This guideline discusses the appropriate use of endoscopy in evaluating patients with dyspepsia. It recommends that patients over 50 years old or those with alarm features should undergo endoscopy due to their higher risk of structural diseases like cancer or peptic ulcers. Younger patients without alarm features may initially receive noninvasive testing for H. pylori infection and be treated if positive, or try acid suppression therapy. If these approaches do not resolve symptoms, endoscopy is recommended to check for structural causes. The guideline aims to help clinicians determine which dyspepsia patients most need endoscopy versus other initial treatment strategies.
Factors associated with developing esophageal adenocarcinoma in Barett's esop...Dr Sayan Das
Based on the study “Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett’s esophagus cohort” by Krishnamoorthi R et al published in “HHS Public Access” on 2016 July
A randomized, multicenter, placebo controlled trial of polyethylene glycol la...Duwan Arismendy
OBJECTIVES:
Polyethylene glycol (PEG) 3350 (MiraLAX) is currently approved for the short-term treatment of occasional constipation. This study was designed to compare the safety and efficacy of PEG laxative versus placebo over a 6-month treatment period in patients with chronic constipation.
METHODS:
Study subjects who met defined criteria for chronic constipation were randomized in this double-blind, placebo-controlled, parallel, multicenter study to receive PEG laxative as a single daily dose of 17 g or placebo for 6 months. Baseline constipation status was confirmed during a 14-day observation period. As a primary efficacy variable, treatment success was defined as relief of modified ROME criteria for constipation for 50% or more of their treatment weeks. Various secondary measures were assessed. An Interactive Voice Response System (IVRS) recorded daily bowel movement experience and study efficacy and safety information. Laboratory testing at baseline and monthly for the study duration was analyzed for hematology, blood chemistry including amylase, GGT, uric acid, lipids, and urinalysis.
RESULTS:
A total of 304 patients were enrolled and received treatment at one of 50 centers. Successful treatment according to the primary efficacy variable was seen in 52.0% of PEG and 11% of placebo subjects (P < 0.001). Similar efficacy was seen in a subgroup of 75 elderly subjects. According to the primary efficacy definition (based on individual treatment weeks), 61% of PEG treatment weeks versus 22% of the placebo weeks were successful (P < 0.001). There were no significant differences in laboratory findings or adverse events except for the gastrointestinal category where diarrhea, flatulence, and nausea were the most frequent with PEG although they were not individually statistically significant compared with placebo. Similar results were observed when analyzed for differences due to gender, race, or age.
Effect of Jianpi-yangwei decoction on gut fungi in the patients with gastric ...LucyPi1
Abstract Background: Our previous study shows that the empirical formula of Chinese medicine Jianpi-yangwei decoction (JYD) can improve the quality of life in patients with gastric cancer undergoing chemotherapy by increasing beneficial gut bacteria and decreasing harmful bacteria. The present study aims to investigate the effect of JYD on gut fungi in patients with gastric cancer undergoing chemotherapy. Methods: A total of 73 patients with gastric cancer undergoing chemotherapy were recruited. Twenty-nine patients in the chemotherapy group were given standard chemotherapy and 44 patients in the observation group were given JYD plus standard chemotherapy. A control group (55 cases) was recruited from the healthy medical examiners. After 3 months of treatment, life-quality score was evaluated and fecal microbiota was tested by high-throughput sequencing based on the 18S rRNA gene. Results: After treatment, life-quality score in the observation group was significantly lower than that in the chemotherapy group (P < 0.05). There was no significant difference between the observation and control groups’ diversity and richness indices of intestinal fungi. The Chao index for intestinal fungi in the chemotherapy group was significantly lower than that in the observation group (P < 0.05). There was a significant difference between the control and chemotherapy groups in the intestinal fungi according to Shannon and Simpson indices (P < 0.05). Linear discriminant analysis effect size analysis showed no significant differences among the three groups, but significant difference in intestinal fungi was observed between the observation group and the chemotherapy group. At the genus level, the relative abundance of the Aspergillus genus in the observation and control groups was significantly lower (P < 0.05), the relative abundance of the Cutaneotrichosporon, Galactomyces, and Ganoderma genus taxa was significantly higher compared with those in the chemotherapy group (P < 0.05), and there was no significant difference between the observation group and control group. Conclusion: JYD can ameliorate chemotherapy-induced fungal dysbacteriosis in patients with gastric cancer undergoing chemotherapy and improve the quality of life of patients.
This document contains summaries of multiple studies related to value-based healthcare for inflammatory bowel diseases. The first study found that a coordinated care program for IBD patients led to less corticosteroid use, more immunomodulator and biologic use, fewer hospitalizations and ER visits, and more biomarker testing compared to matched controls. The second study quantified patients' preferences for disease control, quality of life, and productivity outcomes using a choice-based survey. The third study evaluated a value-based healthcare program for IBD and found less corticosteroid use and trends toward more appropriate medication use and decreased utilization compared to matched controls.
Mc clave et_al-2016-journal_of_parenteral_and_enteral_nutritionAdiel Ojeda
This document provides guidelines for nutrition support therapy in adult critically ill patients from the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and the Society of Critical Care Medicine (SCCM). It summarizes the methodology used to develop the guidelines, which included compiling clinical questions, performing literature searches, and using the GRADE system to evaluate evidence and develop recommendations. The target population is adult critically ill patients expected to have an ICU stay greater than 2-3 days. Nutrition therapy is defined as the provision of enteral or parenteral nutrition, while standard therapy refers to IV fluids and advancement to oral diet as tolerated.
Combined use of AFP, CEA, CA125 and CAl9-9 improves the sensitivity for the d...Enrique Moreno Gonzalez
The detection of serum tumor marker becomes a common method for screening tumors. However,
this method has not been widely used for routine gastric cancer screening. In this study we aimed to determine
whether the combined use of tumor markers may increase the sensitivity for the diagnosis of gastric cancer.
This study compared the effects of epidural analgesia and patient-controlled analgesia on patients undergoing laparoscopic right colectomy or low anterior resection. The study found that:
1) Epidural analgesia was associated with faster return of bowel function by 1 day in patients undergoing low anterior resection, but not in patients undergoing right colectomy.
2) Epidural analgesia provided significantly better pain control compared to patient-controlled analgesia for both right colectomy and low anterior resection patients.
3) However, epidural analgesia alone was inadequate for pain control in 28% of patients, who required the addition of patient-controlled analgesia.
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
This journal club presentation summarized a study on the relationship between obesity and the severity of non-alcoholic fatty liver disease (NAFLD). The presentation included:
- An overview of the systematic review and meta-analysis that examined 13 studies with over 11,000 NAFLD patients to compare clinical features between non-obese and obese NAFLD.
- Key results showing obesity was associated with higher liver enzymes and inflammation scores, but not higher NAFLD activity scores or prevalence of NASH. Obesity was also correlated with increased liver fibrosis in NAFLD patients.
- The methodology involved assessing study quality, extracting data on patient characteristics and outcomes, and using statistical analyses to evaluate differences between
This study analyzed data from over 27,000 patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent elective colorectal resection from 2012 to 2015. The study found that while mechanical bowel preparation alone did not reduce postoperative infections, the combination of mechanical and antibiotic bowel preparation resulted in significantly fewer surgical site infections and Clostridium difficile infections compared to no preparation or antibiotic preparation alone. The authors conclude that combined mechanical and antibiotic bowel preparation should be used for elective colorectal resections when possible due to its effectiveness in reducing infectious complications.
This study compared patient knowledge, satisfaction, and decision-making preferences regarding liver disease care in the USA, urban China (Beijing), and rural China (Hebei). A survey of 990 patients across the three regions found that mean knowledge and satisfaction scores were highest in the USA, followed by Beijing, and lowest in Hebei. US patients preferred shared decision-making more than Chinese patients, who generally preferred doctors to make decisions. Higher knowledge scores and preferences for shared decision-making correlated with greater satisfaction. Understanding these differences may help improve patient outcomes.
Prospective Study of Acute Appendicitis with its Clinical, Radiological Profi...semualkaira
Acute appendicitis is the most common condition encountered in general surgical practice. Alvarado and Modified Alvarado Scores (MASS) are the commonly used scoring
systems for its diagnosis, but its performance has been found to
be poor in certain populations. Hence, we compared the RIPASA
score with MASS, to find out which is a better diagnostic tool for
acute appendicitis in the Indian population.
Alimentacion nasogastrica vs nasoyeyunal en pancreatitis agudaFerstman Duran
A randomized study compared early nasogastric (NG) versus nasojejunal (NJ) feeding in 50 patients with severe acute pancreatitis. Patients were randomized to receive feeding via NG tube or NJ tube. There were no significant differences between the groups in markers of the acute inflammatory response, pain scores, or complications. Both NG and NJ feeding were well tolerated. The simpler NG feeding approach was found to be as effective as NJ feeding in patients with severe acute pancreatitis.
Works Cited Milne, Anne C., Alison Avenell, and Jan Potter. Meta-.docxkeilenettie
Works Cited
Milne, Anne C., Alison Avenell, and Jan Potter. "Meta-Analysis: Protein and Energy Supplementation in Older People."
Annals of Internal Medicine
144.1 (2006): 37-48.
ProQuest.
Web. 1 Oct. 2014.
Meta-Analysis: Protein and Energy Supplementation in Older People Anne C. Milne, MSc; Alison Avenell, MD; and Jan Potter, MBChB Background: Protein and energy undernutrition is common in older people, and further deterioration may occur during illness. Purpose: To assess whether oral protein and energy supplementa tion improves clinical and
nutritional outcomes for older people in the hospital, in an institution, or in the community. Data Sources: Cochrane Central Register of Controlled Trials (CEN TRAL), MEDLINE, EMBASE,
HealthStar, CINAHL, BIOSIS, and CAB abstracts. The authors included English- and non-English-language studies and hand-searched journals, contacted manufacturers, and sought information from trialists. The date of the most recent search of CENTRAL and MEDLINE is June 2005. Study Selection: Randomized and quasi-randomized controlled tri als of oral protein and energy
supplementation compared with placebo or control treatment in older people. Data Extraction: Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Data Synthesis: Fifty-five trials were included (n = 9187 randomly tions (Peto odds ratio, 0.72 [95% Cl, 0.53 to 0.97]) and reduced mortality (Peto odds ratio, 0.66 [CI, 0.49 to 0.90]) for those un dernourished at baseline. Few studies reported evidence that suggested any change in mortality, morbidity, or function for those given supplements at home. Ten trials reported gastrointestinal disturbances, such as nausea, vomiting, and diarrhea, with oral supplements. Limitations: The quality of most studies, as reported, was poor, particularly for concealment of allocation and blinding of outcome assessors. Many studies were too small or the follow-up time was too short to detect a statistically significant change in clinical out come. The clinical results are dominated by 1 very large recent trial in patients with stroke. Although this was a high-quality trial, few participants were undernourished at baseline. Conclusions: Oral nutritional supplements can improve nutritional status and seem to reduce mortality and complications for under nourished elderly patients in the hospital. Current evidence does not support routine supplementation for older people at home or for well-nourished older patients in any setting. assigned participants). For patients in short-term care hospitals who were given oral supplements, evidence suggested fewer complica-Ann Intern Med. 2006:144:37-48. For author affiliations, see end of text.
www.annals.OIJ
ndernutrition among older people is a continuing source of concern (1, 2). Older people have longer periods of illness and longer hospital stays (3), and data show tha.
Dr.NAGARJUNA JOURNAL - GUM CHEWING REDUCES POST OPERATIVE ILEUS?Butkuri Nagarjuna
This document summarizes a systematic review and meta-analysis on the effect of gum chewing in reducing postoperative ileus. The review included 9 randomized controlled trials with a total of 437 patients who underwent elective intestinal surgery. The meta-analysis found that gum chewing was associated with a shorter time to passing flatus (reduced by 14 hours) and stool (reduced by 23 hours), as well as a shorter hospital stay (reduced by 1.1 days). However, the evidence was limited by the small sample sizes of the included studies and lack of details on randomization and blinding methods. While gum chewing appears to be a low-cost intervention, more rigorous studies are still needed to confirm its benefits.
Proton Pump Inhibitors and Risk of Acute and Chronic Kidney Disease: A Retros...KhalafAlGhamdi
This document summarizes a study presented at a nephrology journal club that examined the association between proton pump inhibitor (PPI) use and the risk of acute kidney injury (AKI) and chronic kidney disease (CKD) using a large health insurance database. The study found that PPI use was associated with a 4-fold higher risk of AKI and a 20% higher risk of CKD compared to non-users. While the results strengthen evidence of this association, limitations include potential residual confounding and inability to account for over-the-counter medication use. The conclusion calls for provider education and deprescribing initiatives to reduce PPI overuse and potential kidney risks.
Positive Oral Contrast for Oncology Patients Naglaa Mahmoud
Routine use of positive oral contrast is not required for oncology patients undergoing follow-up CT scans according to a retrospective study. A survey found patients found oral contrast the least pleasant part of the scan. An audit of 447 patients found the bowel could be adequately identified in 90% without oral contrast and no cases required recall. On secondary review, the bowel could be identified in 95% without missed diseases, suggesting oral contrast is not necessary for accurate interpretation of follow-up oncology CT scans.
This study examined levels of the protein inter-alpha inhibitor protein (IaIp) in infants with necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), and controls. The study found:
1) Mean IaIp levels were significantly lower in infants with NEC compared to infants with SIP and controls.
2) IaIp levels distinguished NEC from SIP with high accuracy, while C-reactive protein levels did not differ between groups.
3) IaIp levels may be a superior biomarker to C-reactive protein for the early detection of NEC.
REVIEW Open AccessWhat happens after treatment Asystema.docxmichael591
This systematic review examined definitions of relapse, remission, and recovery from anorexia nervosa (AN) in previous studies. The review found that definitions varied substantially between studies, with some using weight criteria alone, others using symptom-based criteria alone, and some combining both. Relapse rates reported in studies ranged from 9-52% depending on the definition used and length of follow-up. There was consensus that risk of relapse is highest in the first year following treatment. The review proposes standardized criteria for defining relapse, remission, and recovery in AN to facilitate comparisons between studies.
1) The study examined 310 children with autism spectrum disorder (ASD) and 1240 typical children as controls to assess the prevalence of small intestinal bacterial overgrowth (SIBO) using hydrogen breath tests.
2) The results found that 31.0% of children with ASD had SIBO, compared to 9.3% of typical children, which was a statistically significant difference.
3) Children with both ASD and SIBO had significantly higher median Autism Treatment Evaluation Checklist (ATEC) scores than children without ASD or SIBO, indicating that SIBO may contribute to worse autism symptoms.
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING.docxfestockton
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING 175CJON.ONS.ORG
C
Nephrotoxicity
Evidence in patients receiving cisplatin therapy
Elizabeth A. Duffy, DNP, RN, CPNP, Wendy Fitzgerald, RN, MSN, PPCNP-BC, CPON®, Kelley Boyle, MSN, RN, PCNS-BC, and Radha Rohatgi, PharmD, BCOP
CISPLATIN IS A PLATINUM COMPOUND THAT HAS BEEN USED as a chemotherapeutic
agent for many different cancers, including ovarian, testicular, lung, cervical,
and bladder cancers (Ruggiero, Rizzo, Trombatore, Maurizi, & Riccardi, 2016;
Santoso, Lucci, Coleman, Shafer, & Hannigan, 2003). The primary dose-
limiting toxicity of cisplatin is nephrotoxicity, a well-known side effect
(Jones, Spunt, Green, & Springate, 2008; Miller, Tadagavadi, Ramesh, &
Reeves, 2010). Nephrotoxicity involves glomerular or tubular dysfunction
of the kidneys after exposure to medications, other treatments, or toxins
(Skinner, 2011). Nephrotoxicity associated with cisplatin is related to accu-
mulation of metabolites in the renal proximal tubule cells of the kidneys,
where about 90% of cisplatin undergoes urinary excretion (Ruggiero et al.,
2016). Accumulation of these metabolites causes direct inflammation; the
production of reactive oxygen species, which leads to oxidative cell damage;
and cell death (Miller et al., 2010; Ruggiero et al., 2016). Many methods are
available to measure kidney function and define nephrotoxicity or acute
kidney injury (see Table 1).
Most patients receiving cisplatin experience acute impairment of glo-
merular and tubular function in varying degrees. Toxicity is dependent on
individual cisplatin pharmacokinetics and is usually more severe with high
total cisplatin doses and when other potential nephrotoxic medications are
given concurrently (Skinner, 2011; Womer, Pritchard, & Barratt, 1985). In one
study, children aged 10 years or older at treatment had a lower glomerular
filtration rate 10 years after therapy compared to children aged younger than
10 years at treatment (Skinner et al., 2009).
Nephrotoxicity can be reversible, but for some individuals, it can result
in permanent kidney injury, chronic progressive renal failure, or renal tubule
function impairment (Skinner et al., 2009). Chronic and severe reductions
of renal function have several sequelae. The immediate impact may be dose
reduction or cessation of potentially lifesaving nephrotoxic chemotherapy,
thereby increasing the risk of relapse or progression of the cancer. In the
event of a disease relapse or progression, changes to renal function may limit
enrollment in phase 1 or 2 clinical trials because of inclusion parameters
related to baseline renal function.
Hydration and diuretics have been used in conjunction with cisplatin
administration for decades to improve the excretion of cisplatin and reduce
the incidence of nephrotoxicity. One method of promoting this excretion is
through osmotic diuresis with mannitol (Morgan et al., 2014). However, the
amount ...
The Alvarado score for predicting acute
appendicitis: a systematic review
Robert Ohle†
, Fran O’Reilly†
, Kirsty K O’Brien, Tom Fahey and Borislav D Dimitrov
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document contains summaries of multiple studies and presentations related to inflammatory bowel disease (IBD). The summaries are:
1) A study that used a choice-based conjoint analysis to quantify IBD patients' preferences for different outcome metrics like disease control, quality of life, and productivity. It found that quality of life was most important on average.
2) A study comparing practice patterns of academic vs. non-academic gastroenterologists, finding differences in medication use, testing, and procedures between the groups.
3) A study evaluating the impact of a coordinated IBD care program, finding reductions in steroid use, imaging, and healthcare utilization compared to matched controls.
This document provides information on direct and indirect inguinal hernias, including their anatomy and symptoms. It also describes the laparoscopic procedure for treating inguinal hernias, including positioning the patient, dissecting the hernia sac, placing and securing mesh to cover the defect laparoscopically, and post-operative care considerations. The advantages of the laparoscopic approach are less tissue disruption, smaller incisions, less pain, and earlier return to normal activities compared to open surgery.
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This study compared the effects of epidural analgesia and patient-controlled analgesia on patients undergoing laparoscopic right colectomy or low anterior resection. The study found that:
1) Epidural analgesia was associated with faster return of bowel function by 1 day in patients undergoing low anterior resection, but not in patients undergoing right colectomy.
2) Epidural analgesia provided significantly better pain control compared to patient-controlled analgesia for both right colectomy and low anterior resection patients.
3) However, epidural analgesia alone was inadequate for pain control in 28% of patients, who required the addition of patient-controlled analgesia.
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
This journal club presentation summarized a study on the relationship between obesity and the severity of non-alcoholic fatty liver disease (NAFLD). The presentation included:
- An overview of the systematic review and meta-analysis that examined 13 studies with over 11,000 NAFLD patients to compare clinical features between non-obese and obese NAFLD.
- Key results showing obesity was associated with higher liver enzymes and inflammation scores, but not higher NAFLD activity scores or prevalence of NASH. Obesity was also correlated with increased liver fibrosis in NAFLD patients.
- The methodology involved assessing study quality, extracting data on patient characteristics and outcomes, and using statistical analyses to evaluate differences between
This study analyzed data from over 27,000 patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent elective colorectal resection from 2012 to 2015. The study found that while mechanical bowel preparation alone did not reduce postoperative infections, the combination of mechanical and antibiotic bowel preparation resulted in significantly fewer surgical site infections and Clostridium difficile infections compared to no preparation or antibiotic preparation alone. The authors conclude that combined mechanical and antibiotic bowel preparation should be used for elective colorectal resections when possible due to its effectiveness in reducing infectious complications.
This study compared patient knowledge, satisfaction, and decision-making preferences regarding liver disease care in the USA, urban China (Beijing), and rural China (Hebei). A survey of 990 patients across the three regions found that mean knowledge and satisfaction scores were highest in the USA, followed by Beijing, and lowest in Hebei. US patients preferred shared decision-making more than Chinese patients, who generally preferred doctors to make decisions. Higher knowledge scores and preferences for shared decision-making correlated with greater satisfaction. Understanding these differences may help improve patient outcomes.
Prospective Study of Acute Appendicitis with its Clinical, Radiological Profi...semualkaira
Acute appendicitis is the most common condition encountered in general surgical practice. Alvarado and Modified Alvarado Scores (MASS) are the commonly used scoring
systems for its diagnosis, but its performance has been found to
be poor in certain populations. Hence, we compared the RIPASA
score with MASS, to find out which is a better diagnostic tool for
acute appendicitis in the Indian population.
Alimentacion nasogastrica vs nasoyeyunal en pancreatitis agudaFerstman Duran
A randomized study compared early nasogastric (NG) versus nasojejunal (NJ) feeding in 50 patients with severe acute pancreatitis. Patients were randomized to receive feeding via NG tube or NJ tube. There were no significant differences between the groups in markers of the acute inflammatory response, pain scores, or complications. Both NG and NJ feeding were well tolerated. The simpler NG feeding approach was found to be as effective as NJ feeding in patients with severe acute pancreatitis.
Works Cited Milne, Anne C., Alison Avenell, and Jan Potter. Meta-.docxkeilenettie
Works Cited
Milne, Anne C., Alison Avenell, and Jan Potter. "Meta-Analysis: Protein and Energy Supplementation in Older People."
Annals of Internal Medicine
144.1 (2006): 37-48.
ProQuest.
Web. 1 Oct. 2014.
Meta-Analysis: Protein and Energy Supplementation in Older People Anne C. Milne, MSc; Alison Avenell, MD; and Jan Potter, MBChB Background: Protein and energy undernutrition is common in older people, and further deterioration may occur during illness. Purpose: To assess whether oral protein and energy supplementa tion improves clinical and
nutritional outcomes for older people in the hospital, in an institution, or in the community. Data Sources: Cochrane Central Register of Controlled Trials (CEN TRAL), MEDLINE, EMBASE,
HealthStar, CINAHL, BIOSIS, and CAB abstracts. The authors included English- and non-English-language studies and hand-searched journals, contacted manufacturers, and sought information from trialists. The date of the most recent search of CENTRAL and MEDLINE is June 2005. Study Selection: Randomized and quasi-randomized controlled tri als of oral protein and energy
supplementation compared with placebo or control treatment in older people. Data Extraction: Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Data Synthesis: Fifty-five trials were included (n = 9187 randomly tions (Peto odds ratio, 0.72 [95% Cl, 0.53 to 0.97]) and reduced mortality (Peto odds ratio, 0.66 [CI, 0.49 to 0.90]) for those un dernourished at baseline. Few studies reported evidence that suggested any change in mortality, morbidity, or function for those given supplements at home. Ten trials reported gastrointestinal disturbances, such as nausea, vomiting, and diarrhea, with oral supplements. Limitations: The quality of most studies, as reported, was poor, particularly for concealment of allocation and blinding of outcome assessors. Many studies were too small or the follow-up time was too short to detect a statistically significant change in clinical out come. The clinical results are dominated by 1 very large recent trial in patients with stroke. Although this was a high-quality trial, few participants were undernourished at baseline. Conclusions: Oral nutritional supplements can improve nutritional status and seem to reduce mortality and complications for under nourished elderly patients in the hospital. Current evidence does not support routine supplementation for older people at home or for well-nourished older patients in any setting. assigned participants). For patients in short-term care hospitals who were given oral supplements, evidence suggested fewer complica-Ann Intern Med. 2006:144:37-48. For author affiliations, see end of text.
www.annals.OIJ
ndernutrition among older people is a continuing source of concern (1, 2). Older people have longer periods of illness and longer hospital stays (3), and data show tha.
Dr.NAGARJUNA JOURNAL - GUM CHEWING REDUCES POST OPERATIVE ILEUS?Butkuri Nagarjuna
This document summarizes a systematic review and meta-analysis on the effect of gum chewing in reducing postoperative ileus. The review included 9 randomized controlled trials with a total of 437 patients who underwent elective intestinal surgery. The meta-analysis found that gum chewing was associated with a shorter time to passing flatus (reduced by 14 hours) and stool (reduced by 23 hours), as well as a shorter hospital stay (reduced by 1.1 days). However, the evidence was limited by the small sample sizes of the included studies and lack of details on randomization and blinding methods. While gum chewing appears to be a low-cost intervention, more rigorous studies are still needed to confirm its benefits.
Proton Pump Inhibitors and Risk of Acute and Chronic Kidney Disease: A Retros...KhalafAlGhamdi
This document summarizes a study presented at a nephrology journal club that examined the association between proton pump inhibitor (PPI) use and the risk of acute kidney injury (AKI) and chronic kidney disease (CKD) using a large health insurance database. The study found that PPI use was associated with a 4-fold higher risk of AKI and a 20% higher risk of CKD compared to non-users. While the results strengthen evidence of this association, limitations include potential residual confounding and inability to account for over-the-counter medication use. The conclusion calls for provider education and deprescribing initiatives to reduce PPI overuse and potential kidney risks.
Positive Oral Contrast for Oncology Patients Naglaa Mahmoud
Routine use of positive oral contrast is not required for oncology patients undergoing follow-up CT scans according to a retrospective study. A survey found patients found oral contrast the least pleasant part of the scan. An audit of 447 patients found the bowel could be adequately identified in 90% without oral contrast and no cases required recall. On secondary review, the bowel could be identified in 95% without missed diseases, suggesting oral contrast is not necessary for accurate interpretation of follow-up oncology CT scans.
This study examined levels of the protein inter-alpha inhibitor protein (IaIp) in infants with necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), and controls. The study found:
1) Mean IaIp levels were significantly lower in infants with NEC compared to infants with SIP and controls.
2) IaIp levels distinguished NEC from SIP with high accuracy, while C-reactive protein levels did not differ between groups.
3) IaIp levels may be a superior biomarker to C-reactive protein for the early detection of NEC.
REVIEW Open AccessWhat happens after treatment Asystema.docxmichael591
This systematic review examined definitions of relapse, remission, and recovery from anorexia nervosa (AN) in previous studies. The review found that definitions varied substantially between studies, with some using weight criteria alone, others using symptom-based criteria alone, and some combining both. Relapse rates reported in studies ranged from 9-52% depending on the definition used and length of follow-up. There was consensus that risk of relapse is highest in the first year following treatment. The review proposes standardized criteria for defining relapse, remission, and recovery in AN to facilitate comparisons between studies.
1) The study examined 310 children with autism spectrum disorder (ASD) and 1240 typical children as controls to assess the prevalence of small intestinal bacterial overgrowth (SIBO) using hydrogen breath tests.
2) The results found that 31.0% of children with ASD had SIBO, compared to 9.3% of typical children, which was a statistically significant difference.
3) Children with both ASD and SIBO had significantly higher median Autism Treatment Evaluation Checklist (ATEC) scores than children without ASD or SIBO, indicating that SIBO may contribute to worse autism symptoms.
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING.docxfestockton
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING 175CJON.ONS.ORG
C
Nephrotoxicity
Evidence in patients receiving cisplatin therapy
Elizabeth A. Duffy, DNP, RN, CPNP, Wendy Fitzgerald, RN, MSN, PPCNP-BC, CPON®, Kelley Boyle, MSN, RN, PCNS-BC, and Radha Rohatgi, PharmD, BCOP
CISPLATIN IS A PLATINUM COMPOUND THAT HAS BEEN USED as a chemotherapeutic
agent for many different cancers, including ovarian, testicular, lung, cervical,
and bladder cancers (Ruggiero, Rizzo, Trombatore, Maurizi, & Riccardi, 2016;
Santoso, Lucci, Coleman, Shafer, & Hannigan, 2003). The primary dose-
limiting toxicity of cisplatin is nephrotoxicity, a well-known side effect
(Jones, Spunt, Green, & Springate, 2008; Miller, Tadagavadi, Ramesh, &
Reeves, 2010). Nephrotoxicity involves glomerular or tubular dysfunction
of the kidneys after exposure to medications, other treatments, or toxins
(Skinner, 2011). Nephrotoxicity associated with cisplatin is related to accu-
mulation of metabolites in the renal proximal tubule cells of the kidneys,
where about 90% of cisplatin undergoes urinary excretion (Ruggiero et al.,
2016). Accumulation of these metabolites causes direct inflammation; the
production of reactive oxygen species, which leads to oxidative cell damage;
and cell death (Miller et al., 2010; Ruggiero et al., 2016). Many methods are
available to measure kidney function and define nephrotoxicity or acute
kidney injury (see Table 1).
Most patients receiving cisplatin experience acute impairment of glo-
merular and tubular function in varying degrees. Toxicity is dependent on
individual cisplatin pharmacokinetics and is usually more severe with high
total cisplatin doses and when other potential nephrotoxic medications are
given concurrently (Skinner, 2011; Womer, Pritchard, & Barratt, 1985). In one
study, children aged 10 years or older at treatment had a lower glomerular
filtration rate 10 years after therapy compared to children aged younger than
10 years at treatment (Skinner et al., 2009).
Nephrotoxicity can be reversible, but for some individuals, it can result
in permanent kidney injury, chronic progressive renal failure, or renal tubule
function impairment (Skinner et al., 2009). Chronic and severe reductions
of renal function have several sequelae. The immediate impact may be dose
reduction or cessation of potentially lifesaving nephrotoxic chemotherapy,
thereby increasing the risk of relapse or progression of the cancer. In the
event of a disease relapse or progression, changes to renal function may limit
enrollment in phase 1 or 2 clinical trials because of inclusion parameters
related to baseline renal function.
Hydration and diuretics have been used in conjunction with cisplatin
administration for decades to improve the excretion of cisplatin and reduce
the incidence of nephrotoxicity. One method of promoting this excretion is
through osmotic diuresis with mannitol (Morgan et al., 2014). However, the
amount ...
The Alvarado score for predicting acute
appendicitis: a systematic review
Robert Ohle†
, Fran O’Reilly†
, Kirsty K O’Brien, Tom Fahey and Borislav D Dimitrov
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document contains summaries of multiple studies and presentations related to inflammatory bowel disease (IBD). The summaries are:
1) A study that used a choice-based conjoint analysis to quantify IBD patients' preferences for different outcome metrics like disease control, quality of life, and productivity. It found that quality of life was most important on average.
2) A study comparing practice patterns of academic vs. non-academic gastroenterologists, finding differences in medication use, testing, and procedures between the groups.
3) A study evaluating the impact of a coordinated IBD care program, finding reductions in steroid use, imaging, and healthcare utilization compared to matched controls.
This document provides information on direct and indirect inguinal hernias, including their anatomy and symptoms. It also describes the laparoscopic procedure for treating inguinal hernias, including positioning the patient, dissecting the hernia sac, placing and securing mesh to cover the defect laparoscopically, and post-operative care considerations. The advantages of the laparoscopic approach are less tissue disruption, smaller incisions, less pain, and earlier return to normal activities compared to open surgery.
The document summarizes updated guidelines for the treatment of colon cancer from the National Comprehensive Cancer Network. Key updates include splitting treatment algorithms between patients with proficient mismatch repair/microsatellite stable tumors and those with deficient mismatch repair/microsatellite high tumors. New pages were added to cover treatment for dMMR/MSI-H patients. Terminology was also modified to be more inclusive. Additional changes were made to footnotes and recommendations for workup, staging, and treatment of localized and metastatic colon cancer.
The document outlines the recommended pre-operative workup for bariatric surgery patients. It includes: 1) completing a medical history and physical exam; 2) conducting routine lab tests, nutritional screening, and women's health evaluations; 3) assessing patients psychosocially and for any endocrine, pulmonary, cardiovascular, or gastrointestinal conditions that could impact surgery. The goal is to optimize patient health and identify any risks prior to their bariatric procedure.
This tumor conference case discusses a 75-year-old female patient who presented with abdominal pain and fever. Imaging found a pancreatic tail mass, as well as lesions in both kidneys suspected to be metastases. She underwent a distal pancreatectomy with splenectomy. Pathology revealed a 6.1cm neuroendocrine tumor of the pancreas, grade 2. Staging was stage II. Surveillance with follow up CT was recommended for curative intent.
Bariatric surgery guidelines have been updated based on long-term studies demonstrating its effectiveness in treating severe obesity and related conditions. The guidelines now recommend considering bariatric surgery for patients with a BMI ≥30 who have obesity-related medical issues, especially if other treatments have failed. Bariatric procedures lead to greater weight loss than other options and higher remission rates of diabetes and other metabolic conditions. Risks of bariatric surgery are low with mortality rates below 1% for most patients.
This meta-analysis compared the efficacy and tolerability of same-day (SaD) versus split-dose (SpD) bowel preparation regimens for colonoscopy. Fourteen randomized controlled trials with over 4,000 participants were included. The analysis found that the proportion of adequate bowel preparation was comparable between SaD and SpD regimens. SaD with bisacodyl was found to have higher odds of adequate preparation than SpD without bisacodyl. SaD also resulted in better sleep quality than SpD. However, overall rates of optimal preparation remained low for both regimens due to heterogeneous protocols. Further research is still needed to determine optimal purgative agents and dosing.
NCCN Guidelines Version 3.2022 Colon Cancer.pdfChanyutTuranon1
- The document presents the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Colon Cancer. It lists the panel members and provides a summary of recent updates made in Version 3.2022.
- Key updates include adding tucatinib in combination with trastuzumab as a treatment option for HER2-amplified metastatic colon cancer, and revising dosing information for HER2-targeted therapies.
- The document presents updated guidelines from the National Comprehensive Cancer Network (NCCN) for the treatment of anal carcinoma.
- Key updates include revising treatment recommendations for metastatic disease and surveillance, capping the mitomycin dose for concurrent chemoradiation regimens, and revising target volume definitions and quality assurance procedures for radiation therapy.
- The guidelines are intended to help clinicians determine the best evidence-based approaches for treating patients with this cancer.
This randomized clinical trial compared the effectiveness and tolerability of split-dose vs same-day whole-dose administration of reduced-volume polyethylene glycol electrolyte lavage solution (PEG-ELS) for bowel preparation prior to morning colonoscopy. The study found that split-dose preparation was as effective as same-day whole-dose preparation for bowel cleanliness, but was better tolerated by patients with fewer experiencing nausea, vomiting, or inability to complete the preparation. Patients in the split-dose group also reported being less likely to refuse the same preparation in the future or want to try another option. The split-dose reduced-volume PEG-ELS preparation may provide an improved bowel cleansing regimen for morning colonoscopy.
Monitor indicators of genetic diversity from space using Earth Observation dataSpatial Genetics
Genetic diversity within and among populations is essential for species persistence. While targets and indicators for genetic diversity are captured in the Kunming-Montreal Global Biodiversity Framework, assessing genetic diversity across many species at national and regional scales remains challenging. Parties to the Convention on Biological Diversity (CBD) need accessible tools for reliable and efficient monitoring at relevant scales. Here, we describe how Earth Observation satellites (EO) make essential contributions to enable, accelerate, and improve genetic diversity monitoring and preservation. Specifically, we introduce a workflow integrating EO into existing genetic diversity monitoring strategies and present a set of examples where EO data is or can be integrated to improve assessment, monitoring, and conservation. We describe how available EO data can be integrated in innovative ways to support calculation of the genetic diversity indicators of the GBF monitoring framework and to inform management and monitoring decisions, especially in areas with limited research infrastructure or access. We also describe novel, integrative approaches to improve the indicators that can be implemented with the coming generation of EO data, and new capabilities that will provide unprecedented detail to characterize the changes to Earth’s surface and their implications for biodiversity, on a global scale.
1. Same-day Versus Split-dose Bowel Preparation
Before Colonoscopy
A Meta-Analysis
Yuan-Lung Cheng, MD,*w Kuang-Wei Huang, MD,z Wei-Chih Liao, MD,*w
Jiing-Chyuan Luo, MD,wy Keng-Hsin Lan, MD, PhD,wy8 Chien-Wei Su, MD, PhD,wy
Yuan-Jen Wang, MD,yz and Ming-Chih Hou, MDwy
Background: Split-dose regimens (SpDs) were recommended as a
first choice for bowel preparation, whereas same-day regimens
(SaDs) were recommended as an alternative; however, randomized
trials compared them with mixed results. The meta-analysis was
aimed at clarifying efficacy level between the 2 regimens.
Materials and Methods: We used MEDLINE/PubMed, EMBASE,
Scopus, CINAHL, Cochrane Library, and Web of Science to
identify randomized trials published from 1990 to 2016, comparing
SaDs to SpDs in adults. The pooled odds ratios (ORs) were cal-
culated for preparation quality, cecal intubation rate (CIR), ade-
noma detection rate (ADR), and any other adverse effects.
Results: Fourteen trials were included. The proportion of individ-
uals receiving SaDs and SpDs with adequate preparation in the
pooled analysis were 79.4% and 81.7%, respectively, with no sig-
nificant difference [OR = 0.92; 95% confidence interval (CI), 0.62-
1.36] in 11 trials. Subgroup analysis revealed that the odds of
adequate preparation for SaDs with bisacodyl were 2.45 times that
for SpDs without bisacodyl (95% CI, 1.45-4.51, in favor of SaDs
with bisacodyl). Subjects received SaDs experienced better sleep.
Conclusions: SaDs were comparable with SpDs in terms of bowel
cleanliness, CIR, and ADR, and could also outperform SpDs in
preparation quality with bisacodyl. SaDs also offered better sleep
the previous night than SpDs did, which suggests that SaDs might
serve as a superior alternative to SpDs. The heterogenous regimens
and measurements likely account for the low rates of optimal bowl
preparations in both arms. Further studies are needed to validate
these results and determine the optimal purgatives and dosages.
Key Words: bowel preparation, same-day regimen, split-dose
regimen
(J Clin Gastroenterol 2017;00:000–000)
Optimal bowel preparation is crucial for increased
effectiveness of colonoscopy in both clinical and
screening settings. However, the requirement of restricted
diets for several days, and an unpalatable (large) volume of
purgatives, made patient tolerance and compliance the
main barriers to adequate bowel preparation. Split-dose
regimens (SpDs) for bowel preparation were shown to
improve colonic cleanliness and adenoma detection, and
are thus recommended as a routine bowel preparation in
guidelines.1,2 The guidelines also recommend that same-day
regimens (SaDs) can be offered to patients as an alternative
for bowel preparation. Both guidelines base their views of
the alternative on a prospective study from Longcroft-
Wheaton and Bhandari,3 which revealed that SaDs were
more effective than SpDs, with fewer adverse effects and
less sleep disturbances. Several randomized trials evaluated
their effects, and revealed mixed results to SpDs; thus, we
performed a meta-analysis to clarify the efficacy and tol-
erability of the 2 regimens.
MATERIALS AND METHODS
Search Strategy and Trial Selection
Systemic searches were performed in October 2016
using MEDLINE/PubMed, EMBASE, Scopus, CINAHL,
Cochrane Library, and Web of Science for randomized
controlled trials. Search terms were: (1) colonoscopy, (2)
bowel preparation, and (3) randomized. Only fully pub-
lished randomized trials with one arm using purgatives on
the day of colonoscopy, with the other arm using purgatives
on the previous day and the day of colonoscopy, were
included. Trials including pediatric patients were excluded.
References from the reviewed articles were searched (in
terms of any articles that may have been missed).
Choice of Outcomes
The primary outcome measure was bowel cleanliness,
defined as adequate or satisfactory preparation—with use
of both unvalidated and validated preparation scales
(Ottawa, Boston, and Aronchick scales). If no adequate
dichotomous result was reported, an excellent or successful
Received for publication December 13, 2016; accepted April 18, 2017.
From the *Taipei Municipal Gan-Dau Hospital; wSchool of Medicine,
Faculty of Medicine; 8Department and Institute of Pharmacology,
National Yang-Ming University; zDepartment of Internal Medicine,
Division of Gastroenterology, Taipei Beitou Health Management
Hospital; yDepartment of Medicine, Division of Gastroenterology;
and zHealthcare Center, Taipei Veterans General Hospital, Taipei,
Taiwan.
supported by grants from Taipei Veterans General Hospital (V105-C-
024), National Yang-Ming University, and the Ministry of Science
and Technology, Taiwan (MOST 104-2314-B-010-013-MY2).
Y.L.C. and W.C.L.: study concept and design, analysis and inter-
pretation of data, drafting of manuscript; K.W.H.: study concept
and design, analysis and interpretation of data;; J.C.L., K.H.L., and
C.W.S.: study concept and design, discussion and support; M.C.H.
and Y.J.W.: overall study concept and design, analysis and inter-
pretation of data, critical revision of the manuscript for intellectual
content and final drafting.
The authors declare that they have nothing to disclose.
Address correspondence to: Ming-Chih Hou, MD, Department of
Medicine, Division of Gastroenterology, Taipei Veterans General
Hospital, 201, Section 2, Shih-Pai Road, Taipei, Taiwan
(e-mail: mchou@vghtpe.gov.tw).
Address correspondence to: Yuan-Jen Wang, MD, Healthcare Center,
Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road,
Taipei, Taiwan (e-mail: yjwang@vghtpe.gov.tw).
Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/MCG.0000000000000860
ORIGINAL ARTICLE
J Clin Gastroenterol Volume 00, Number 00, ’’ 2017 www.jcge.com | 1
Copyright r 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
This paper can be cited using the date of access and the unique DOI number which can be found in the footnotes.
2. preparation was used for analysis. If no information on
colon preparation quality was offered, then right side colon
cleanliness was used for the sensitivity analysis. SpDs were
defined as the administration of primary purgatives on the
day before colonoscopy, as well as the day of the procedure.
SaDs were defined as having no primary purgative the day
before the colonoscopy, but adjuvants were allowed.
Secondary outcomes included cecal intubation rate
(CIR), adenoma detection rate (ADR), patient willingness
to repeat the preparation, sleep disturbance, and side effects
including nausea, vomiting, and abdominal pain/cramps.
Validity Assessment
Two investigators (Y.L.C. and K.W.H.) assessed
citation eligibility, with any discrepancies resolved by an
independent reviewer (M.C.H.). The quality of the trials
was graded using the Cochrane risk bias tool. Then 2
authors independently validated data extraction and other
entries.
Statistical Analysis
Preplanned sensitivity analyses assessing bowel clean-
liness examined SpDs for varying volume versus that in
SaDs. Values for intention-to-treat were preferred to per-
protocol when both were presented. We included non-
compliant patients or withdrawals in the intention-to-treat
analysis to minimize bias, whereas missing values were
assumed to have a poor outcome. No attempt at deter-
mining values from graphics or figures was performed to
avoid possible subjectivity.
Statistical analysis was conducted with Review Man-
ager (Version 5.3; Cochrane Collaboration, Oxford, GB).
Outcomes of dichotomous variables were presented as odds
ratios (ORs) and 95% confidence intervals (CIs). Statistical
heterogeneity was assessed using the Higgins I2
test. The
DerSimonian and Laird random effects model was used for
the pooled analysis. Subgroup analysis was performed to
characterize heterogeneity, with results including 3 trials
were reported in sensitivity analyses.
RESULTS
Study Selection and Characteristics
Overall, 484 citations were retrieved, 259 articles were
rejected on the basis of titles and abstracts, 225 articles were
reviewed, and 14 articles were included (Fig. 1).4–17 A fully
published article with an abstract, which clearly mentioned
SaD versus SpD preparation, was excluded because of an
unavailable full text.18
Table 1 summarizes the characteristics of 14 trials,
comparing SaD and SpD bowel preparations. The quality
of bowel cleanliness was evaluated with Aronchick, Ottawa,
and Boston scales in 11 trials, whereas 3 trials used unva-
lidated scales.11,12,16 Clean colon preparation was reported
but not defined in 1 trial.16 Scores 5 in the Ottawa scale
were considered adequate in 2 studies,7,13 and Cesaro et al4
revealed only excellent preparation as a score r3, whereas
Zhang et al17 counted a score 7 as a successful prepara-
tion. Three trials did not document dichotomous outcomes
of bowel cleanliness.6,9,14
Three trials also used bisacodyl 10 to 20 mg in the arm
of SaD preparation,4,10,16 and 2 trials used bisacodyl in
both arms the previous evening5,12; the other 9 trials did not
use adjuvants in either arm. Two trials had different diet
restriction in the 2 arms,13,16 and 1 trial did not describe the
preparation diet at all.15 Other trials had the same diet
restriction during preparation in both arms.
According to the American Society for Gastro-
intestinal Endoscopy (ASGE) guidelines, the second dose of
SpDs should be administered 3 to 8 hours before the start
of colonoscopy.19 Colonoscopy was performed in the time
window in 7 trials,5–8,11,13,17 whereas another 4 trials might
have included patients who did not have a colonoscopy
within the optimal interval4,12,14,15; whether colonoscopy
timing was optimal could not be distinguished in the other
3 trials.9,10,16
No significant publication bias was detected for the
primary outcome of quality of bowel preparation by visual
evaluation of the funnel plot (Fig. 2). The Cochrane risk
bias tool mapped the authors’ judgments about each risk of
item bias, as seen in Figure 3. One study used a poor
method in the sequence generation process.5
Quality of Bowel Preparation
Kotwal et al9 concluded that there was no significant
difference between groups with decent preparation for any
segment of the colon, but did not reveal information about
the rate of adequate or satisfactory bowel cleanliness.
FIGURE 1. Flowchart for the inclusion of studies.
Cheng et al J Clin Gastroenterol Volume 00, Number 00, ’’ 2017
2 | www.jcge.com Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.
Copyright r 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
This paper can be cited using the date of access and the unique DOI number which can be found in the footnotes.
3. TABLE 1. Summaries and Jadad Score of Studies Included in the Meta-Analysis
References
Study
Type/
Location
No.
Patients
(Same
Day/
Split)
Definition of
Adequate or
Satisfactory Diet During Preparation Bowel Preparation Type
Colonoscopy
Timing
Jadad
Score
Cesaro
et al4
RCT
Italy
50/51 Ottawa scale.
Excellent
scorer3
Low-residue diet for 3 days
and clear liquid since the
start of bowel preparation
Same day: bisacodyl
10-20 mg at 10 PM the
day prior; PEG-CS 2 L
6 AM of the day
Split: 3 L PEG 7 PM the day
prior; 1 L PEG 7 AM of the
day
11:00-18:00 2
Chan et al5 RCT
Malaysia
152/143 BBPS.
Satisfactory as
good or
intermediate
Low-residue diet the day
prior, clear liquid after
6 PM the day prior
Same day: 2 L PEG 5-6 am
Split: 1 L PEG 8-8:30 PM, 1 L
PEG 5:30-6:00 AM
Both: bisacodyl 5 mg 2
tablets for 2 evenings
Morning 1
Chen et al6 RCT
China
51/49 Aronchick
scale.
No
dichotomous
outcome
Fasting after 6 PM the day
prior
Same day: 3 L PEG 8 AM of
the day
Split: NaP 8 PM the day prior
and 8 AM of the day
Afternoon
(13:00-
16:00)
2
Kang et al7 RCT
Korea
98/99 Ottawa scale.
Adequate
score 5
Low-residue diet for 3 d Same day: SP 6 AM and
10 AM of the day
Split: 2 L PEG at 6 PM the
day prior, 2 L PEG 5 h
before colonoscopy
Afternoon 3
Kim et al8 RCT
Korea
50/150 Aronchick scale
Excellent and
good as
adequate
Ottawa scale
scores were
reported
Low fiber diet for 3 d Same day: 4 L PEG 6 h
before colonoscopy split:
1. 2 L PEG 6 PM the day
prior, 2 L PEG 4-6 h
before colonoscopy
2. SPMC 1 sachet 6 PM the
day prior; 1 sachet 4-6 h
before colonoscopy
3. SPMC 1 sachet 6 PM, 1
sachet 9 PM the day prior; 1
sachet 4-6 h before
colonoscopy
Not described 1
Kotwal
et al9
RCT
USA
60/60 Ottawa scale.
No
dichotomous
outcome
Clear liquid the day prior Same day: 4 L PEG 5-9 AM of
the day
Split: 2 L PEG 7-9 PM the day
prior; 2 L PEG 7-9 AM of
the day
After 11am 3
Kwon
et al10
RCT
Korea
92/97 BBPS.
ScoreZ6
adequate
Low fiber diet for 3 d, soft
meal the day prior
Same day: bisacodyl 20 mg
8 PM the day prior; 1 L
PEG/Asc 6 AM of the day
Split: 1 L PEG/Asc 8 PM the
day prior and 1 L PEG/
Asc 6 AM of the day
Not described 3
Matro
et al11
RCT
USA
65/60 Unvalidated 4-
point scale.
Adequate as
excellent and
good
Low-residue breakfast
before 10 AM the day prior,
clear liquid up to 2.5 hours
before
Same day: 1 L PEG 7 h
before, 1 L PEG 4 h before
Split: 1 L PEG 6 PM the day
prior, 1 L PEG 4 h before
colonoscopy
Afternoon 3
Parra-
Blanco
et al12
RCT
Spain
43/45 Unvalidated 5-
point scale.
Good and
excellent
score 4
Low fiber diet the day prior,
clear liquid after
completing bowel
preparation
Same day: 3 L PEG 6 AM of
the day
Split: NaP 8 PM the day prior;
NaP 6 AM of the day
Both: bisacodyl 15 mg the
day prior
09:00-15:00 2
Seo et al13 RCT
Korea
103/102 Ottawa scale.
Adequate
score 5
Low-residue diet for 3 d Same day: 2 L PEG 5 h
before colonoscopy
Split: 2 L PEG at 6 PM the
day prior; 2 L PEG 5 h
before
09:00-17:00 3
J Clin Gastroenterol Volume 00, Number 00, ’’ 2017 Same-day Versus Split-dose Bowel Preparation
Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved. www.jcge.com | 3
Copyright r 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
This paper can be cited using the date of access and the unique DOI number which can be found in the footnotes.
4. Shah et al14 provided information only about average
Ottawa scores, and did not disclose adequate bowel prep-
aration in either group. Chen et al6 showed SpD was better
than SaD, but the trial did not offer dichotomous infor-
mation. In the analysis of the remaining 11 studies, 79.4%
(735/926) of patients using SaDs had adequate bowel
cleanliness, whereas the proportion of patients with the
same level of bowel cleanliness was 81.7% (846/1036) with
SpDs (Fig. 4). The pooled analysis revealed comparable
bowel cleanliness in the 2 arms (OR = 0.92; 95% CI, 0.62-
1.36) with substantial heterogeneity (I2
= 60), so subgroup
analysis evaluated the influence of bisacodyl on bowel
cleanliness. Comparing SaDs with bisacodyl to SpDs
without it the previous evening showed the results favored
SaDs in bowel cleanliness (OR, 2.45; 95% CI, 1.45-4.15;
I2
= 0%). If both arms eliminated adjuvants, the analysis
revealed that SpDs had better bowel cleanliness with no
heterogeneity (OR, 0.66; 95% CI, 0.49-0.88) (Table 2).
CIR and ADR
CIRs were reported in 6 studies, whereas 94.1% and
94.6% of patients using SaDs and SpDs achieved cecal
intubation, respectively.4,5,7,9,13,15 The OR ratio was 0.87
(95% CI, 0.49-1.54) with no heterogeneity existing between
the 2 arms with I2
= 0%. ADRs were found in 7 studies
and the results were 26.7% and 29.4% in SaDs and SpDs,
respectively.4,5,7,11,13,15,17 The OR was 0.87 (95% CI, 0.67-
1.13) with low heterogeneity (I2
= 12%) (Figs. 5, 6).
Patient Tolerance
Willingness to repeat, plus completion of bowel prep-
aration fluid, was reported in 8 and 11 trials, respectively.
There was no significant difference between the 2 arms
(Table 3). Side effects including nausea, vomiting, and
abdominal pain/cramps also revealed no significant differ-
ence in the meta-analysis. The 95% CIs were 0.86-1.85,
0.58-1.91, and 0.75-1.72, respectively, with substantial het-
erogeneity. Eight trials provided information about sleep
disturbances, with analysis showing that patients using
SaDs had better sleep quality (OR, 0.44; 95% CI, 0.24-
0.82).7,8,11,13–17
DISCUSSION
The quality of bowel preparation is essential for
screening colonoscopy to identify precancerous or cancer-
ous lesions. Patient compliance with diet restriction and
large-volume purgative consumption was important to
TABLE 1. (continued)
References
Study
Type/
Location
No.
Patients
(Same
Day/
Split)
Definition of
Adequate or
Satisfactory Diet During Preparation Bowel Preparation Type
Colonoscopy
Timing
Jadad
Score
Shah
et al14
RCT
India
103/97 Ottawa scale.
No
dichotomous
outcome
Liquid diet the day prior,
clear liquid after midnight
Same day: 2 L PEG 5-7 AM of
the day
Split: 1 L PEG 6-7 PM the day
prior, 1 L PEG 6-7 AM of
the day
11:00-16:00 3
Tellez-
Avila
et al15
RCT
Mexico
61/67 BBPS.
Satisfactory
score 2 or 3
Not described Same day: 2 L PEG 6-8 AM of
the day
Split: 2 L PEG 5-7 PM the day
prior; 2 L PEG 6-8 AM of
the day
Not described 3
van Vugt
van
Pinxte-
ren
et al16
RCT
Netherlands
53/63 Unvalidated 4-
point scale.
Clean colon
rate reported
but not
defined
Same day: lightly digestible
products for 2 d, fluid on
the day prior
Split: light breakfast and
lunch day prior
Same day: 4 L PEG
unspecified time of day;
MgSO4 15 g and bisacodyl
10 mg the day prior
Split: NaP evening the day
prior; NaP 3 h before
colonoscopy
Afternoon 2
Zhang
et al17
RCT
China
159/159 Ottawa scale.
Successful
score 7
Low-residue food the day
prior
Same day: 2 L PEG 4-6 h
before colonoscopy
Split: 1 L PEG at 9 PM the
day prior; 2- PEG
4-6 h before colonoscopy
Not described 3
Asc indicates ascorbic acid; BBPS, Boston Bowel Preparation Scale; CS, citrates and simethicone; NaP, sodium phosphate; PEG, polyethylene glycol; RCT,
randomized controlled trial; SPMC, sodium picosulfate with magnesium citrate.
FIGURE 2. Funnel plot. No significant publication bias noted in
primary outcome. OR indicates odds ratio.
Cheng et al J Clin Gastroenterol Volume 00, Number 00, ’’ 2017
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5. achieve better quality of bowel preparation. In this meta-
analysis, we found SaDs to be comparable with SpDs in
terms of bowel cleanliness, CIR, and ADR, as they out-
performed SpDs in bowel cleanliness, with the addition of
bisacodyl. Patients receiving SaDs also experienced better
sleep the previous night.
The standard bowel preparation for colonoscopy was
adapted from methods to prepare patients for abdominal
FIGURE 3. Cochrane risk bias tool.
FIGURE 4. Forest plot comparing bowel cleanliness for SaDs versus SpDs. CI indicates confidence interval. M-H indicates Mantel-
Haenszel.
TABLE 2. Primary Outcome: Adequate Bowel Cleanliness
Outcomes
No.
Trials
No. All
Patients OR (95% CI)
Ratio in Arms
[Same Day/Split (%)]
Heterogeneity
(P)
I2
(%)
Same day with bisacodyl vs. split
without bisacodyl
3 406 2.45 (1.45-4.15)
Favors same-day
dosing
85.1/72.0 0.92 0
Same day without bisacodyl vs. split
without bisacodyl
6 1173 0.66 (0.49-0.88)
Favors split-dosing
73.7/81.5 0.61 0
Same day with bisacodyl vs. split
with bisacodyl
2 383 0.58 (0.21-1.60) 89.2/93.1 — —
CI indicates confidence interval; OR, odds ratio.
J Clin Gastroenterol Volume 00, Number 00, ’’ 2017 Same-day Versus Split-dose Bowel Preparation
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6. surgery; purgatives were taken and finished the evening
before colonoscopy.20 In the 1990s, investigators started to
challenge the traditional preparation methods: Frommer21
concluded that SpD with sodium phosphate (NaP) was
better than NaP or polyethylene glycol (PEG) the day
before (in terms of efficacy with bowel cleansing). Church
also suggested that the timing of PEG administration was
the major quality determinant of bowel preparation, and
speculated an optimal time window for bowel cleansing
after gut lavage; this was because of the influx of small-
bowel contents into the colon after the optimal time
window.22,23 A meta-analysis reviewed 38 further trials
comparing the efficacy of bowel cleansing between SpDs
and day before regimens; it was concluded that SpDs were
better in terms of the quality of bowel preparation.24 SpDs
were recommended by ASGE as a routine bowel prepara-
tion in the guidelines as well, with an interval of 3 to 8
hours between the second dose of SpDs and the time of
colonoscopy for optimal cleansing.19
However, SpDs can interrupt sleep, cause nocturnal
incontinence, and influence the function of patients during
the preparation period. Therefore, several studies were
FIGURE 5. Forest plot for SaDs versus SpDs on cecal intubation rate. CI indicates confidence interval. M-H indicates Mantel-Haenszel.
FIGURE 6. Forest plot for SaDs versus SpDs on adenoma detection rate. CI indicates confidence interval. M-H indicates Mantel-
Haenszel.
TABLE 3. Secondary Outcomes: Patient Tolerance
Outcomes No. Trials No. All Patients OR (95% CI)
Ratio in Arms
[Same Day/Split (%)] Heterogeneity (P) I2
(%)
Willingness to repeat 8 1251 1.08 (0.45-2.61) 75.1/72.3 0.001 89
Completion of bowel
preparation
11 1966 0.89 (0.45-1.78) 90.2/90.5 0.001 70
Side effects
Any side effects 6 936 0.86 (0.53-1.39) 39.4/41.3 0.04 57
Nausea 11 2038 1.26 (0.86-1.85) 29.6/25.7 0.001 70
Vomiting 10 1937 1.05 (0.58-1.91) 11.1/9.4 0.001 70
Abdominal pain/cramps 11 2038 1.14 (0.75-1.72) 13.3/12.5 0.02 51
Sleep disturbance 8 1489 0.44 (0.24-0.82)
Favors same-day dosing
22.3/37.4 0.001 83
CI indicates confidence interval; OR, odds ratio.
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7. performed to establish the hypothesis that gut lavage on the
day of colonoscopy would provide equal efficacy in bowel
cleanliness, along with reduced preparation time and less
adverse effects. Longcroft-Wheaton and Bhandari3 pro-
spectively assigned patients to SpD or SaD with sodium
picosulphate (SP) before colonoscopy, with the results
revealing that SaD offered better quality of bowel cleanli-
ness, and less impairment in daily activities and adverse
effects. This meta-analysis reviewed 14 randomized trials
comparing SaDs to SpDs, such that the pooled analysis
disclosed that SaDs offered equal quality of bowel prepa-
ration and less sleep disturbance. Accordingly, SaDs could
be a better alternative to SpDs because of increased toler-
ance, along with equal bowel preparation quality.
Heterogeneity was noted among studies, which sug-
gested disagreements in findings, and several factors could
be responsible for the heterogeneity (Table 1). First, reg-
imens used in SaD and SpD arms varied. PEG is asso-
ciated with less electrolyte imbalance and used in both
arms of most trials.2 Four trials used the same volume of
PEG in both arms: 1 trial found that SpD had a better
quality score without reporting adequate preparation
rate,14 and the other 3 trials revealed no significant dif-
ference between SaDs and SpDs.5,8,11 Five studies used
different volumes of PEG in 2 arms: Kwon et al10 (1 L SaD
vs. 2 L SpD), Seo et al13 (2 L SaD vs. 4 L SpD), and Tellez-
Avila et al15 (2 L SaD vs. 4 L SpD) showed no significant
difference between the 2 arms. However, the study by
Zhang et al17 compared 2 L PEG SaD to 3 L PEG SpD,
with the result showing that SpD was significantly better
than SaD (79.2% vs. 89.9% in SaD and SpD, respectively,
P = 0.008). On the contrary, Cesaro et al4 found sig-
nificantly more adequate preparations for 2 L PEG SaD
plus bisacodyl compared with 4 L PEG SpD (70% vs.
49%, P = 0.033). Although most trials administered PEG
solution in both arms, 5 trials used different purgatives in
2 arms. Chen et al6 showed a better score in the cleansing
effect of NaP SpD than 3 L PEG SaD, the other 4 trials
found no difference between SaDs and SpDs (Kang et al7
compared SP SaD to 4 L PEG SpD, Kim et al8 compared
4 L PEG SaD to SP SpD, Parra-Blanco et al12 compared
3 L PEG SaD to NaP SpD, and van Pinxteren et al16
compared 4 L PEG SaD to NaP SpD). Second, colono-
scopy was performed in 3 to 8 hours after the admin-
istration of the last dose of purgatives (the optimal
window) in 7 trials.19 Five trials found no difference
between 2 arms in bowel cleansing effect,5,7,8,11,13 whereas
the other 2 trials showed SpDs had a significantly higher
rate of adequate preparation than SaDs.6,17 As for the 4
trials including patients not having a colonoscopy within
the optimal interval, 1 trial found that SpD was better in
bowel cleansing,14 whereas another trial showed that SaD
had a better performance than SpD.4 There was no sig-
nificant difference of preparation quality in the other 2
trials.12,15 Third, the definition of adequate bowel prepa-
ration varied between studies. Although Ottawa scale was
used most frequently among studies, Boston and Aron-
chick scales were also used in 5 studies,5,6,8,10,15 and 3
studies evaluated bowel preparation quality by unvali-
dated scales.11,12,16 Fourth, a wide range of diet plans
during preparation among studies could be another factor
responsible for the heterogeneity. Provided with the het-
erogenous designs between studies, further large-scale
homogeneous studies are needed to validate our result that
SaDs could be a better alternative to SpDs.
Patient compliance is a crucial factor regarding the
quality of bowel preparations. Large liquid volumes (4 L)
were used to achieve an optimal cathartic effect. However,
high-volume purgatives can cause nausea, vomiting,
abdominal fullness, and cramping.19 Therefore, several
adjuvants were studied to reduce the required volume of
purgatives and to increase the quality of bowel preparation,
showing that bisacodyl was the most promising agent
among them. By 1994, Adams et al25 designed a random-
ized trial to demonstrate that bisacodyl could improve
colon preparation, including a reduced volume of PEG,
along with better tolerance among patients. Later, Ker26
and Parente et al27 came to the same conclusion, that is,
that the addition of bisacodyl in either regimen could
achieve an equal bowel cleaning result with a lower volume
of purgatives. Other than NaP and PEG, bisacodyl also
enhanced the strength of SP in terms of its effectiveness of
bowel preparations.28 In our review, 5 studies took
advantage of bisacodyl,4,5,10,12,16 and 3 of them adminis-
tered bisacodyl only in the SaD arm.4,10,16 The subgroup
analysis showed that bisacodyl could assist SaDs towards
achieving better quality of bowel preparation than SpDs,
without the addition of bisacodyl (Table 2). Accordingly,
bisacodyl taken the previous evening was essential for
optimizing SaDs. However, the broad 95% CI between 1.45
and 4.51 indicates that the result needs further studies to
validate.
ASGE releases quality indicators for improvement,
and recommends that CIR should be 90% in all exami-
nations, and 95% in screening colonoscopy.29 CIR showed
no difference between SaDs and SpDs in our study; how-
ever, although CIR was over 90% in all other trials
reporting the quality indicator, Kotwal et al9 found CIR at
86.3% and 84.6% in SaDs and SpDs arms, respectively.
The inclusion of hospitalized patients with different indi-
cations could explain the low CIR.
ADR is identified as another primary indicator by
ASGE: a minimum target for it in a population over 50
years old should be Z25% (for men Z30%, for women
Z20%). In the meta-analysis, no difference in ADR was
noted between the 2 arms. However, ADR was 25% in
both arms among ADR-reported trials, except those of
Tellez-Avila et al15, Cesaro et al,4 and Matro et al11 The
ADR in the SpD arm of Matro and colleagues was 24.1%
and that in the SaD arm of Cesaro and colleagues was
18% while Tellez-Avila and colleagues reported unac-
ceptably low ADR in both arms, with an average age of
patients about 55 years (1.7% and 8.2% in SaDs and
SpDs, respectively). Furthermore, ADR in the SaD arm of
the trial from Cesaro and colleagues was lower than in the
SpD arm (18% vs. 34%), even though SaD achieved
greater cleanliness than SpD. The inconsistency between
bowel preparation quality and ADR was also noted in
previous studies.30,31 Jover et al31 reported ADR being
associated with excellent colon cleanliness was lower than
those with good to fair cleanliness. Calderwood and col-
leagues evaluated bowel preparation quality and ADR,
with the Boston Bowel Preparation Scale (BBPS), and
found ADR associated with total BBPS scores of 6, 7, and
8 was higher than those with a score of 9. (BBPS 6: 40.4%,
BBPS 7: 40.6%, BBPS 8: 38.8% vs. BBPS 9: 34.4%).
Distraction or a false sense of confidence in an excellent
preparation should be avoided in the inspection phase.30
Other variables should be searched and analyzed in future
studies.
J Clin Gastroenterol Volume 00, Number 00, ’’ 2017 Same-day Versus Split-dose Bowel Preparation
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8. This meta-analysis demonstrated that over 90% of
patients could finish the preparation fluid in both arms, and
that nausea/vomiting/abdominal pain happened in both
arms as well, but without a significant difference. However,
sleep disturbance occurred less often with SaDs. Patients in
2 trials, who needed to wake up early to finish bowel
preparation for morning colonoscopy, still had better sleep
quality.13,14 The result suggested that SaDs could serve as
a viable alternative to SpDs, with the additional benefit of
increased patient compliance.
The strength of this study is that it used only
randomized controlled trials performed in China, Korea,
Malaysia, India, Italy, Spain, Netherlands, Mexico, and the
United States, so the results could be applied to all pop-
ulations. However, there are several limitations. First, the
heterogenous measurement of preparation quality by a mix
of validated and unvalidated scores was the likely reason
that the pooled rate of adequate preparation in these 2
groups (79.4% and 81.7%) was lower than what was typ-
ically reported (most studies looking at SpD preparation
showed rates of adequate preparation 90%). Second, the
diet during preparation varied among studies and
the length of time for diet restriction also differed, so the
influence on bowel cleanliness could not be further ana-
lyzed. Third, studies used different purgatives with various
dosages in SaDs and SpDs, so the superiority among them
could not be determined. Fourth, adverse effects and sleep
disturbance were analyzed in a dichotomous manner, so
that bias might exist in these subjective variables. Fifth,
most studies excluded patients with surgical bowel resec-
tion, major psychiatric illness, severe cardiac, hepatic, or
renal failure, such that conclusions from this meta-analysis
could not be widely applied.
In conclusion, SaDs were comparable with SpDs in
bowel cleanliness, CIR, and ADR, and could outperform
SpDs in bowel cleanliness with the addition of bisacodyl.
SaDs also offered better sleep the previous night than SpDs.
This suggests that SaDs with bisacodyl could serve as a
superior alternative to SpDs. Further studies are needed to
validate the results and determine optimal purgatives and
dosages.
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J Clin Gastroenterol Volume 00, Number 00, ’’ 2017 Same-day Versus Split-dose Bowel Preparation
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