Do adjuvants add to the efficacy and tolerance of bowel preparations? A meta-analysis of randomized trials

Endoscopy ◽  
2017 ◽  
Vol 50 (02) ◽  
pp. 159-176 ◽  
Author(s):  
Sophie Restellini ◽  
Omar Kherad ◽  
Charles Menard ◽  
Myriam Martel ◽  
Alan Barkun
Keyword(s):  
Randomized Trials ◽  
Low Dose ◽  
Meta Analysis ◽  
High Dose ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Adenoma Detection Rates ◽  
Split Dosing ◽  
Bowel Preparations ◽  
The Impact

Abstract Background and study aims Recommendations on adjuvant use with bowel preparations remain disparate. We performed a meta-analysis determining the clinical impact of adding an adjuvant to polyethylene glycol (PEG), sodium phosphate, picosulfate (PICO), or oral sulfate solutions (OSS)-based regimens. Methods Systematic searches were made of MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge for randomized trials from January 1980 to April 2016 that assessed preparations with or without adjuvants, given in split and non-split dosing, and PEG high- (> 3 L) or low-dose (≤ 2 L) regimens. Bowel cleansing efficacy was the primary outcome. Secondary outcomes included patient willingness to repeat the procedure, and polyp and adenoma detection rates. Results Of 3093 citations, 77 trials fulfilled the inclusion criteria. Overall, addition of an adjuvant compared with no adjuvant, irrespective of the type of preparation and mode of administration, yielded improvements in bowel cleanliness (odds ratio [OR] 1.23 [1.01 – 1.51]) without greater willingness to repeat (OR 1.40 [0.91 – 2.15]). Adjuvants combined with high-dose PEG significantly improved colon cleansing (OR 1.96 [1.32 – 2.94]). The odds for achieving adequate preparation with low-dose PEG with an adjuvant were not different to high-dose PEG alone (OR 0.95 [0.73 – 1.22]), but yielded improved tolerance (OR 3.22 [1.85 – 5.55]). However, split high-dose PEG yielded superior cleanliness to low-dose PEG with adjuvants (OR 2.53 [1.25 – 5.13]). No differences were noted for OSS and PICO comparisons, or for any products regarding polyp or adenoma detection rates. Conclusions Critical heterogeneity precludes firm conclusion on the impact of adjuvants with existing bowel preparations. Additional research is required to better characterize the methods of administration and resulting roles of adjuvants in an era of split-dosing.

Sizing of Polyp Illustrations Differs by Endoscopists’ Gender and Improves With a Measurement Reference

2019 ◽  
Vol 43 (4) ◽  
pp. 270-273 ◽  
Author(s):  
Nabiha Shamsi ◽  
Aasma Shaukat ◽  
Sofia Halperin-Goldstein ◽  
Joshua Colton
Keyword(s):  
Colorectal Cancer ◽  
Cancer Surveillance ◽  
Community Based ◽  
Polyp Size ◽  
Detection Rates ◽  
Demographic Groups ◽  
Adenoma Detection ◽  
Adenoma Detection Rates ◽  
Colorectal Cancer Surveillance ◽  
The Impact

Colorectal cancer surveillance intervals by colonoscopy are based on the size and number of polyps removed. Evidence suggests endoscopists’ estimation of polyp size is often inaccurate, but the differences by endoscopists’ characteristics have not been reported. This study assesses endoscopists’ accuracy of measuring polyp illustrations, the effect of endoscopists’ characteristics, and the impact of having a measurement reference. Endoscopists in a community-based, gastroenterology practice estimated the size of several illustrations in a booklet. One month later, they estimated the size of illustrations with a provided measurement reference. Accuracy was defined as no difference between estimated and actual value. Endoscopists were accurate in sizing only 15% of the time, with a tendency toward undersizing. Female endoscopists, those with less than 10 years in practice and those with lower adenoma detection rates, were more likely to undersize polyps. Accuracy of measuring the polyp illustrations increased to 50% ( p < .01) with the measurement reference. The improvement in accuracy was seen across endoscopists’ demographic groups. Endoscopists had poor accuracy of measuring polyp illustrations. Almost universally, endoscopists tended to undersize the polyp illustrations. Accuracy improved significantly with the use of a polyp-measuring guide, particularly when considering important surveillance thresholds of 5 and 10 mm.

Time Trends in Detection of Sessile Serrated Adenomas: The Impact of the 2010 WHO Guidelines and Adenoma Detection Rates

2017 ◽  
Vol 112 ◽  
pp. S54-S55
Author(s):  
Joseph Marsano ◽  
Gabriela Kuftinec ◽  
Brian Paciotti ◽  
Machelle Wilson ◽  
Sheeva Johnson ◽  
...  
Keyword(s):  
Time Trends ◽  
Who Guidelines ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Adenoma Detection Rates ◽  
The Impact ◽  
Serrated Adenomas

Endocuff vision-assisted vs. standard polyp resection in the colorectum (the EVASTA study): a prospective randomized study

Endoscopy ◽  
2019 ◽  
Vol 52 (01) ◽  
pp. 45-51 ◽  
Author(s):  
Guido von Figura ◽  
Moritz Hasenöhrl ◽  
Bernhard Haller ◽  
Alexander Poszler ◽  
Jörg Ulrich ◽  
...  
Keyword(s):  
Randomized Study ◽  
Colorectal Polyps ◽  
University Hospital ◽  
Standard Group ◽  
Withdrawal Time ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Adenoma Detection Rates ◽  
Standard Colonoscopy ◽  
The Impact

Abstract Background Cap-assisted colonoscopy is frequently used to facilitate adenoma detection during endoscopy. However, data on how cap assistance influences polyp resection are scarce. We aimed to evaluate the impact of cap assistance with the Endocuff vision device (EVD) on the resection time for colorectal polyps in patients undergoing colonoscopy. Methods A randomized, prospective study was performed in a university hospital in Germany. A total of 250 patients were randomly assigned 1:1 to undergo either colonoscopy with the EVD (EVD arm) or standard colonoscopy without the use of a cap (standard arm). The primary outcome was the average duration of polypectomy. Secondary outcomes included adenoma detection rate, cecal and ileal intubation times, and propofol dosage. Results The use of EVD led to a significant reduction in the median polypectomy time in the EVD vs. standard arm (54 vs. 80 seconds, respectively; P = 0.02). This effect was strongest for polyps ≥ 6 mm. Compared with the standard group, Endocuff assistance also resulted in a shorter cecal intubation time (6 vs. 8 minutes; P = 0.03) and overall colonoscopy time (23 vs. 27 minutes; P = 0.02). In contrast, no difference in withdrawal time was observed. The polyp and adenoma detection rates did not differ significantly between the two groups. Conclusion Endocuff-assisted colonoscopy reduces the duration of polypectomy, which may be due to a more stable scope position during resection. Further studies are needed to investigate whether comparable effects will be seen for other interventions, such as clipping or biopsy sampling.

The Impact of Timed Colonoscopy Withdrawal on Adenoma Detection Rates at a Community Hospital

2010 ◽  
Vol 105 ◽  
pp. S568 ◽  
Author(s):  
Diego Valencia ◽  
Mark Metwally ◽  
Victor Ciofoaia ◽  
Annie Gaudioso ◽  
William Hale ◽  
...  
Keyword(s):  
Community Hospital ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Adenoma Detection Rates ◽  
The Impact

scholarly journals The Dose-Dependent Efficacy of Cefepime in the Empiric Management of Febrile Neutropenia: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Nikolaos Andreatos ◽  
Myrto Eleni Flokas ◽  
Anna Apostolopoulou ◽  
Michail Alevizakos ◽  
Eleftherios Mylonakis
Keyword(s):  
Febrile Neutropenia ◽  
Low Dose ◽  
Meta Analysis ◽  
Treatment Discontinuation ◽  
High Dose ◽  
First Line ◽  
The Impact ◽  
Dose Dependent ◽  
Overall Mortality

Abstract Background Despite reports questioning its efficacy, cefepime remains a first-line option in febrile neutropenia. We aimed to re-evaluate the role of cefepime in this setting. Methods We searched the PubMed and EMBASE databases to identify randomized comparisons of (1) cefepime vs alternative monotherapy or (2) cefepime plus aminoglycoside vs alternative monotherapy plus aminoglycoside, published until November 28, 2016. Results Thirty-two trials, reporting on 5724 patients, were included. Clinical efficacy was similar between study arms (P = .698), but overall mortality was greater among cefepime-treated patients (risk ratio [RR] = 1.321; 95% confidence interval [CI], 1.035–1.686; P = .025). Also of note, this effect seemed to stem from trials using low-dose (2 grams/12 hours, 100 mg/kg per day) cefepime monotherapy (RR = 1.682; 95% CI, 1.038–2.727; P = .035). Cefepime was also associated with increased mortality compared with carbapenems (RR = 1.668; 95% CI, 1.089–2.555; P = .019), a finding possibly influenced by cefepime dose, because carbapenems were compared with low-dose cefepime monotherapy in 5 of 9 trials. Treatment failure in clinically documented infections was also more frequent with cefepime (RR = 1.143; 95% CI, 1.004–1.300; P = .043). Toxicity-related treatment discontinuation was more common among patients that received high-dose cefepime (P = .026), whereas low-dose cefepime monotherapy resulted in fewer adverse events, compared with alternative monotherapy (P = .009). Conclusions Cefepime demonstrated increased mortality compared with carbapenems, reduced efficacy in clinically documented infections, and higher rates of toxicity-related treatment discontinuation. The impact of cefepime dosing on these outcomes is important, because low-dose regimens were associated with lower toxicity at the expense of higher mortality.

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