Polyethylene glycol versus sodium phosphate in bowel cleansing for colonoscopy: a randomized trial

BACKGROUND AND STUDY AIMS: There have been conflicting results regarding the adverse effects of established bowel cleansing regimens. The aim of the present study was to compare the effects of three bowel cleansing regimens on subjective well-being, electrolyte balance, cardiac arrhythmia, and the microscopic post-cleansing appearance of the colonic mucosa. PATIENTS AND METHODS: A total of 231 consecutive outpatients were randomly assigned to receive bowel preparation for colonoscopy with either 4 l polyethylene glycol (PEG; group I, n = 76); 2 l PEG plus 10 mg Bisacodyl (group II, n = 71); or 90 ml sodium phosphate (group III, n = 84). After bowel preparation, the participants completed a questionnaire on symptoms. Endoscopists blinded to the regimen used gave scores for the quality of cleansing at endoscopy, ranging from poor (0) to very good (5). Blood samples were taken before and after bowel cleansing, electrocardiographic monitoring was used during colonoscopy, and mucosal biopsy samples were taken in the sigmoid colon. RESULTS: Bowel preparation in group II was poorer (mean score 3.26) than in groups I (3.88) and III (4.01); P < 0.001 (II vs. III), P < 0.001 (I vs. II). The frequency of arrhythmias and post-cleansing mucosal inflammation was similar in all three groups. Lower serum potassium and higher serum phosphate concentrations were found in group III in comparison with the other groups ( P < 0.001). CONCLUSIONS: No differences were detected regarding the effectiveness and safety of bowel preparation with PEG alone and sodium phosphate in individuals without cardiac, renal, or hepatic failure, despite a significantly stronger alteration of the electrolyte balance with sodium phosphate.     

聚乙二醇电解质溶液在结肠镜检查前肠道准备中的应用与护理

目的研究口服聚乙二醇电解质溶液2 000 ml在肠镜检查前肠道准备中的效果和安全性。方法将100例行结肠镜检查的病人随机分为实验组和对照组,实验组口服聚乙二醇电解质溶液清肠,对照组口服电解质溶液加蓖麻油清肠。观察服药后的排便次数和性状,肠道清洁程度,病人服药后的反应,肠腔内气泡情况。服药前、结肠镜检查结束时分别测心率、血压,进行血、尿常规检查和电解质测定。结果实验组肠道准备时间较对照组明显缩短,两组差异有显著意义;两组清洁肠道有效率均达100%,无明显差异;不良反应实验组明显少于对照组;在耐受性方面,实验组优于对照组。结论口服聚乙二醇电解质溶液清洁肠道效果佳,安全性好,可替代我科传统的电解质溶液加蓖麻油清肠方法。     

Intravenous hyoscine as a premedication for colonoscopy: a randomized double-blind controlled trial

BACKGROUND AND STUDY AIMS: There is wide variation in the use of antispasmodics to facilitate colonoscopy, both within and between countries, and its use before such procedures remains controversial. The aim of this study was to determine whether there was any objective benefit in using hyoscine as a premedication for colonoscopy in a district general hospital. PATIENTS AND METHODS: Consecutive day-case patients undergoing colonoscopy were included in the study. They were prospectively randomly allocated to receive either intravenous hyoscine (n = 61) or intravenous placebo (n = 56) as part of their premedication. RESULTS: Our analysis demonstrated no statistically significant difference between the two groups with respect to the median time from colonoscope insertion to caecal intubation (9.7 minutes in the hyoscine group vs. 8.3 minutes in the placebo group) or the median total procedure time (14.8 minutes in the hyoscine group vs. 13.8 minutes in the placebo group). There was also no statistically significant difference in success rates for caecal intubation between the two groups ( P < 0.06). However a type II error cannot be excluded because of the small sample size. CONCLUSION: This study demonstrated no obvious benefit in the routine use of hyoscine as a premedication for colonoscopy in a district general hospital setting.     

单瓶磷酸钠盐口服溶液在结肠镜检查前肠道准备中的效果分析

目的研究单瓶磷酸钠盐口服溶液在结肠镜检查前肠道准备中的效果。方法连续选择拟行结肠镜检查的患者160例,随机分为两组,每组80例,分别接受复方聚乙二醇电解质散(A组)和口服磷酸钠盐溶液(B组)进行结肠镜前肠道准备。内镜医师单盲法记录肠道清洁程度,并通过问卷调查记录患者耐受性及不良反应发生情况。结果两种方法均能达到较满意的清洁效果,两组相比,差异无显著性,P>0.05。肠道准备可耐受率B组明显多于A组,P<0.01。结论单瓶磷酸钠盐口服溶液完全可以达到与标准聚乙二醇相同的肠道准备效果,且耐受性更高。     

低容量聚乙二醇电解质散联合首荟通便胶囊在慢性功能性便秘患者结肠镜检查肠道准备中的应用研究

目的 探讨与标准大容量聚乙二醇电解质散（4L PEG-ELS）方案相比,低容量PEG-ELS联合首荟通便胶囊（SHLC）方案对慢性功能性便秘（CFC）患者结肠镜检查前肠道准备的有效性和安全性。方法 采用单中心、观察者盲法、随机对照试验方法,招募2021年1月-2021年12月在山东大学齐鲁医院（青岛）接受结肠镜检查的CFC患者282例,随机分配到SHLC+2 L PEG-ELS组、SHLC+3 L PEG-ELS组和4 L PEG-ELS组。观察患者波士顿肠道准备评分（BBPS）和肠道准备耐受性。结果 最终纳入240例患者。SHLC+2 L PEG-ELS、SHLC+3 L PEG-ELS和4 L PEG-ELS组的BBPS分别为（6.22±1.09）、（6.26±0.97）和（7.06±0.63）分,差异无统计学意义（P> 0.05）。节段性BBPS显示,3组患者在左半结肠[（2.32±0.72）、（2.41±0.64）和（2.58±0.59）分]、中段结肠[（2.18±0.83）、（2.26±0.76）和（2.44±0.81）分]和右半结肠[（1.67±0.71）、（1.72...     

Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial

Introduction  

Succinylcholine and rocuronium are widely used to facilitate rapid sequence induction (RSI) intubation in intensive care. Concerns relate to the side effects of succinylcholine and to slower onset and inferior intubation conditions associated with rocuronium. So far, succinylcholine and rocuronium have not been compared in an adequately powered randomized trial in intensive care. Accordingly, the aim of the present study was to compare the incidence of hypoxemia after rocuronium or succinylcholine in critically ill patients requiring an emergent RSI.     

老年患者不同时间服用复方聚乙二醇电解质散肠道准备的效果

目的：比较老年患者分次剂量与单次全剂量服用复方聚乙二醇电解质溶液进行肠道准备的效果及不良反应,总结肠道准备的护理经验。方法将220例行结肠镜检查的老年患者根据计算机生成的随机数字表分为试验组和对照组,每组110例。试验组患者于结肠镜检查前1 d 17：00及检查当日6：00分次剂量服用复方聚乙二醇电解质散(PEG),每次1.5 L;对照组患者检查当日6：00单次全剂量服用PEG 3L清洁肠道。采用Boston肠道准备量表( BBPS)评估肠道清洁度,比较两组患者的不良反应及检查阳性率。结果试验组患者 BBPS 评分为(6.65±1.67)分,对照组患者 BBPS 评分为(6.14±1.91)分,两组比较差异有统计学意义(t=2.097,P<0.05)。试验组患者呕吐14例、腹痛34例、腹胀22例,均低于对照组(χ2值分别为4.400,4.111,4.002;P<0.05);试验组结肠息肉及结肠癌检出率为37.3%,高于对照组的24.5%(χ2=4.172,P<0.05)。结论采用结肠镜检查前当晚与检查当日分次剂量服用PEG可以改善肠道清洁效果,减少老年患者单次大量服用 PEG引起的不良反应,提高检查阳性率。     

Fractional cleansing of the large bowel with "Golytely" for colonoscopic preparation: a controlled trial

"Golytely", a lavage solution for colonoscopic preparation, has been in clinical use since 1980. Patients usually drink all the fluid (4-61 "Golytely") the morning before colonoscopy. However, clinical observation shows that many, especially elderly, patients have difficulty tolerating these large volumes. We therefore compared two methods of drinking "Golytely" in 36 patients: One group of 18 patients underwent a two-stage lavage preparation (in the evening and the following morning before the examination), the other group drank all the fluid in the early morning before colonoscopy. Patients tolerated the two-stage method significantly better-in terms of nausea (p less than 0.05) and their willingness to repeat the procedure (p less than 0.001). In both groups the bowel was equally clean and the amount of fluid required for preparation did not differ. We conclude that this new method of drinking "Golytely" is far more convenient for the patient and does not reduce the effectiveness of bowel preparation.     

Memories of colonoscopy: a randomized trial

Patients' memories of the past may influence their decisions about the future, yet memories are imperfect and susceptible to bias. We tested whether a memory failure observed in psychology experiments could be applied in a clinical setting to lessen patients' memories of the pain of an unpleasant medical procedure. We studied consecutive outpatients undergoing colonoscopy who were medically stable, mentally competent, and able to speak English (n=682). By random assignment, half the patients had a short interval added to the end of their procedure during which the tip of the colonoscope remained in the rectum. Pain during the procedure was measured with a ten point intensity scale. Memory following the procedure was measured using both a rating scale and a ranking task. Randomization resulted in two similar groups. As theorized, patients who underwent the extended procedure experienced the final moments as less painful (1.7 vs. 2.5 on a ten point intensity scale, P<0.001), rated the entire experience as less unpleasant (4.4 vs. 4.9 on a 10 cm visual analogue scale, P=0.006), and ranked the procedure as less aversive compared to seven other unpleasant experiences (4.1 vs. 4.6 with eight as the worst, P=0.002). Rates of returning for a repeat colonoscopy (median duration of follow-up 5.3 years) averaged 50.4% and were slightly higher (odds ratio=1.41, P=0.038) for those who underwent the longer procedure controlling for prior colonoscopy, procedure indications, and abnormal findings. Memory failures observed in experimental conditions can be found in clinical settings involving awake patients and may offer opportunities for improving patients' willingness to undergo future unpleasant medical procedures.     

Carbon dioxide field flooding versus mechanical de-airing during open-heart surgery: a prospective randomized controlled trial

Removal of intracardiac air during valvular surgery should be accomplished in the most effective manner. We conducted a prospective randomized controlled trial to compare mechanical de-airing and carbon dioxide (CO2) field flooding in 18 patients undergoing elective valvular surgery. Transoesophageal echocardiography was used to record intracardiac bubbles, and this was assessed postoperatively by two independent echocardiographers blinded to treatment group. Both assessors graded the bubble count higher in the mechanical deairing group compared with the CO2 flooding group, and there was good agreement between assessors. CO2 field flooding is more effective than mechanical de-airing in removing intracardiac bubbles following valvular surgery.     

Comparison of a new colon lavage solution (Iso-Giuliani) with a standard preparation for colonoscopy: a randomized study

Iso-Giuliani is a new improved-taste isoosmotic PEG-electrolyte solution for colon cleansing. In a randomized study, we have compared the effectiveness, tolerance and patient acceptance of 3 dosage volumes of this solution with a standard preparation in 191 patients undergoing colonoscopy. Iso-Giuliani 3 1, and 4 1 proved better colonic preparations as compared with the standard preparation (P less than 0.01). However Iso-Giuliani, 21 was sufficient for satisfactory cleansing, especially in the rectosigmoid. Patients in the standard preparation group experienced more cramps than did those in Iso-Giuliani groups. Patient acceptance was significantly better for Iso-Giuliani than for the standard preparation. The ingestion of Iso-Giuliani represents a safe, effective and well-accepted method of colon cleansing, and is our elective method of preparation for colonoscopy.     

Improvement in colonoscopy performance with adjunctive magnetic endoscope imaging: a randomized controlled trial

BACKGROUND AND STUDY AIM: Although magnetic endoscope imaging (MEI) has been reported to improve the performance of colonoscopy, so far only a few randomized controlled studies have been published supporting its adjunctive role. This randomized study was designed to evaluate the role of MEI on the overall performance of colonoscopy. PATIENTS AND METHODS: Patients admitted for elective colonoscopy were recruited. They were randomly allocated into two groups, either with an MEI view (study group) or without (control group). Examinations were performed by one of the two designated, trained endoscopists. The primary end point was intubation time. Other outcome measures included completion rate, pain score graded by patients, and ease of procedure as reflected by the number of attempts at straightening the scope, the number of times of hand pressure was applied abdominally, and the need to change the patient's position. Endoscopists were also asked to score the ease of procedure. Finally, in the MEI group, endoscopists were asked to comment on whether MEI helped to locate colonic lesions during endoscopy. RESULTS: In a 12-month period, 120 patients were recruited, with 60 patients in each group. The two groups were matched for age, gender distribution, and indications for colonoscopy. No complication occurred in either group. No significant difference was observed in the intubation time and colonoscopy completion rate. Other measures of ease of procedure and pain score were also similar. However, MEI was reported by endoscopists to be helpful in locating colonic lesions in 32 % of examinations with positive findings. CONCLUSION: For trained endoscopists, the device confers no benefit in terms of performance improvement. The only identified benefit is in locating lesions. Thus, while the routine use of MEI cannot be recommended, the device could be selectively offered to patients for follow-up examination after local treatment, or to patients with small colorectal tumors in whom laparoscopic surgery is planned.     

磷酸钠盐灌肠液在儿童结肠镜检查中的应用研究

[目的]探讨磷酸钠盐灌肠液在儿童结肠镜检查中清洁肠道的安全性和可行性。[方法]选取2011年4月-11月2岁以上需要应用结肠镜检查或手术的患儿60例,根据肠道清洁方法的不同分别应用磷酸钠盐灌肠液（试验组）和口服番泻叶（对照组）行肠道准备,观察患儿不良反应、肠腔清洁度、肠道清洁范围,其中肠道清洁程度和范围通过电子肠镜判断。[结果]两组患儿不良反应发生率差异有统计学意义（P〈0.05）;试验组肠道清洁有效率达93.3%,明显高于对照组（70.0%,P〈0.05）;试验组肠道清洁范围满意率达96.7%,明显高于对照组（73.3%,P〈0.01）。[结论]2岁以上儿童结肠镜检查前应用磷酸钠盐灌肠液进行肠道准备效果优于口服番泻叶法。     

Long-term treatment of irritable bowel syndrome: results of a randomized controlled trial

To examine the long-term management of irritable bowel syndrome we conducted a two-part controlled therapeutic trial on 28 patients who had recovered completely after four to six weeks of treatment with ispaghula husk and propantheline. In part I patients were randomly divided into two groups. Group A received a placebo capsule while Group B continued with treatment as before. After six months the response to treatment was assessed according to a scoring system. The overall relapse rate in Group B was 46 per cent compared to 82 per cent in group A. With continued treatment patients in Group B became asymptomatic from the fourth month while patients in Group A continued to deteriorate. In part II, patients who had relapsed whilst on placebo received active treatment. Six of the seven who agreed to continue with the study became asymptomatic within four weeks. However, all the patients who were asymptomatic while on active treatment relapsed on discontinuation and again recovered on reinstitution of active treatment. We conclude that irritable bowel syndrome is a chronic relapsing disorder and that treatment with a combination of ispaghula husk and propantheline is effective, both in relieving symptoms and in the maintenance of remission.     

Short versus long axis ultrasound guided approach for internal jugular vein cannulations: A prospective randomized controlled trial

ObjectivesUltrasound-guided internal jugular vein cannulation is a standard procedure performed in ICUs worldwide. According to the guidelines, the short-axis approach is recommended over the long-axis approach for IJV cannulation. Double-operator cannulation is more convenient for the said procedure. However, the guidelines favor single-operator cannulation due to limited trials. We hypothesized that double-operator long-axis cannulation will be faster and have fewer complications than double-operator short-axis cannulation.MethodsThis was a prospective, randomized trial of patients who needed central venous catheterization in the intensive care unit. The eligible patients were randomized into two groups. In one group, the short-axis view by two operators was used for cannulation, and the long-axis view by 2 operators was used in the other group. The time elapsed from skin puncture to guide-wire insertion.ResultsThe central venous catheter was placed by ultrasound guidance in all 100 patients. No significant differences were observed in the patient characteristics between the two groups. The mean time of insertion was 74.2 ± 110.1 s with the short-axis approach compared with 70.3 ± 97.3 s with the long-axis approach. The frequency of complications was also significantly lower with the long-axis approach.DiscussionThe long-axis view for IJV cannulation has similar insertion and procedure timings to the short-axis view. However, the complication rate and number of needle punctures required were less with the long-axis view than with those with the short-axis view.