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7026 Double blind randomised controlled trial comparing carbon dioxide and air insufflation during colonoscopy; assessing patient bloating, discomfort and satisfaction.
7026 DOUBLE BLIND RANDOMISED CONTROLLED TRIAL COMPARING CARBON DIOXIDE AND AIR INSUFFLATION DURING COLONOSCOPY; ASSESSING PATIENT BLOATING, DISCOMFORT AND SATISFACTION. John E. Painter, Andrew Pascoe, Rob Edwards, Wendy Atkin, Christie Hosp NHS Trust, Manchester, United Kingdom; John Radcliffe Hosp, Oxford, United Kingdom; ICRF Colorectal Cancer Unit, London, United Kingdom. Aim: To determine if the routine use of carbon dioxide, as opposed to air, insufflation during colonoscopy significantly reduces patient discomfort and bloating, thus increasing satisfaction. Method: 104 consecutive volunteers, aged 55 to 65, attending for a screening colonoscopy or for adenoma assessment as part of the MRC Flexiscope trial, were randomly allocated to receive either carbon dioxide or air insufflation. Carbon dioxide was delivered to the video-endoscopes using the Olympus Endoscopic CO2 regulator. The volunteers completed a questionnaire the morning after the colonoscopy and posted it to an independent address. Procedural and post-procedural discomfort and bloating were measured using 100mm visual analogue scales. Global measures of physical discomfort, anxiety and satisfaction were obtained using a previously validated satisfaction questionnaire . Results: 104 volunteers agreed to participate in the trial, questionnaires were received from 89 participants (86% return rate). Analyses were performed on an intention to treat basis. No significant difference was found for global discomfort, anxiety or satisfaction measured using the satisfaction questionnaire (Mann-Whitney U test). Conclusion: The routine use of carbon dioxide insufflation in colonoscopy significantly reduces bloating both during and after the procedure and post-procedural discomfort, but not procedural discomfort. There was no impact on global assessment of discomfort, anxiety or satisfaction. This research was made possible through an MRC grant to fund the Flexiscope trial.
Visual analogue scale results, median (inter-quartile range) Gas used CO2 Air p value
Bloating (during)
Bloating (after)
6 (3 - 41) 26 (4 - 55) 0.041
11 (2 - 43) 40 (7 - 61) 0.034
Discomfort (during) 28 (4 - 67) 40 (7 - 61) NS
Discomfort (after) 5 (2 - 21) 17 (5 - 52) 0.016
Mann-Whitney U test. 7027 COMPARISON OF FLEXIBLE SIGMOIDOSCOPIC FINDINGS IN SYMPTOMATIC INDIVIDUALS AND IN THOSE REFERRED FOR ROUTINE CANCER SCREENING. Waqar A. Qureshi, Kamran Ayub, Mary C. Heiser, B. S. Anand, Baylor Coll of Medicine and VA Med Ctr, Houston, TX. Background: Flexible sigmoidoscopy (FS) is frequently used as the initial diagnostic study in patients presenting with symptoms believed to indicate disease of the lower gastrointestinal tract such as iron deficiency anemia, rectal bleeding, and new onset change in bowel habit. However, it is unclear how predictive these symptoms are of colonic pathology. The present study was carried out to examine this issue and to compare the results obtained with those seen in a group of asymptomatic individuals referred for routine screening for colon cancer. Methods: A total of 701 subjects comprising of 577 individuals undergoing screening FS and 124 patients with lower GI symptoms were included in the study. The subjects were examined using a 60 cm flexible sigmoidoscope by a single observer. All subjects had a phosphate enema bowel prep. Results: All study subjects were males. The mean (±SD) age of the asymptomatic group (65±10 years) was significantly greater than symptomatic individuals (61±12 years; p <0.001). The findings at flexible sigmoidoscopy in the two groups is shown in the Table. Abnormal findings were noted in 73% patients with GI symptoms which was significantly greater than that in individuals undergoing screening FS (62%; ). The most common abnormal finding was polyps, seen in 59% of symptomatic subjects compared to 42% in the symptomatic group (p<0.001). No significant difference was observed in the prevalence of colon cancer between the two groups. Comment: The present study shows that although endoscopic abnormalities are seen more frequently in symptomatic individuals, nearly 40% of an unselected asymptomatic veteran population had colonic polyps. Our observations substantiate the findings of previous studies that precancerous lesions occur frequently in our older population and reinforce the concept of routine screening for all individuals over the age of 50 years. Diagnosis Normal Polyps Cancer Hemorroids
AB248
Asymptomatic 213 243 11 13
(37%) (42%) (1.9%) (2.3%)
Symptomatic 19 73 2 7
(15%) (59%) (1.6%) (5.6%)
GASTROINTESTINAL ENDOSCOPY
7028 DIAGNOSTIC AND THERAPEUTIC CAPACITY OF EMERGENCY ENDOSCOPY. Diego Rincon, Cecilia G. Asanza, Javier Vaquero, Maria Escudero, Maria Vega Catalina, Carmen Senent, Paloma Jimenez, Sonia Alonso, Enrique Cos, Pedro Menchen, H G U Gregorio Maranon, Madrid, Spain; Hgu Gregorio Maranon, Madrid, Spain. Background: Although emergency endoscopy plays an important role in diagnosis and management of digestive emergencies, the inmediacy with which this procedure should be performed remains controversial. Aims: 1) Evaluate which percentage of emergency endoscopic procedures gave a main benefit for patient´s prognosis. 2)Analyze the diagnosis capacity of the emergency endoscopy. Methods: Between January and September 1999, 1115 urgent endoscopic procedures were evaluated (1042 gastroscopies and 73 colonoscopies) in 1060 patients (65.1% males, 34.9% females, mean age 60.2 years). Mean time of endoscopy was 5.3 hours after admision, and the distribution in the journey was: morning 25.4%, afternoon and evening 41.7%, and night 32.9%. We defined an exploration as “really urgent” when the endoscopic procedure gave a direct prognosis and therapeutic benefit, on the basis of: diagnosis of variceal bleeding, need of endoscopic therapeutic procedures, foreing bodies removal and caustic injury. Results: the main indication why the endoscopies were asked for were: suspect of upper gastrointestinal bleeding (UGIB, 81.1%), foreing bodies (9.3%), caustic injury (2%), critical lower gastrointestinal bleeding (LGIB, 4%), large bowel volvulus (2%), and ischemic colitis (1.3%). Diagnosis capacity in the UGIB was 95.3%; the only factor related with it was the patient´s age, being older the group not diagnosed (66.1 vs 60.3 years, p<0.05). Diagnosis capacity in the LGIB was 65.5%. 38,86% of the endoscopies carried out fullfiled the criteria of “really urgent”. Conclusions: 1) In our experience, a third of the patients get a benefit of carrying out an early endoscopy. 2) Diagnosis capacity of the emergency in our means is not different from the results of other published series.
p value <0.001 <0.001 ns <0.05
7029 NEW METHOD OF NUTRITIONAL MANAGEMENT FOR HEAD AND NECK CANCER Yutaka Suzuki, Ryuuta Ninomiya, Nobuo Omura, Fumiaki Yano, Nobuyoshi Hanyu, Teruaki Aoki, The Jikei Univ Sch of Medicine, Tokyo, Japan; Jikei Univ Sch of Medicine, Tokyo, Japan. Background: Head and Neck Surgery (tongue, larynx, pharynx and upper jaw) of recent year became possible with the introduction of microscopic surgery and patients QOL has been improved dramatically, the length of hospital stay also shortened. However, generally nutritional support have been managed by ‡@intravenous-hyperalimentation or ‡Aenteral feeding via nasal. In case of IVH, it has prevented early discharge from hospital and early recovery of social activities and in case of enteral feeding via nasal tube, it inflicted pain in patients and prevented early discharge from hospital. As we have adapted percutaneous endoscopic gastrostomy (PEG) to improve nutritional status of patients who are scheduled for surgical operation for head and neck cancer, to start early enteral feeding, and early discharge from hospital, we report the method and the result. Subject and Method: Subjects were 12 patients in Ear and Nose Dept. who have been operated (4 cases of tongue cancer, 3 cases of oral floor cancer, 3 cases of upper jaw and 2 cases of lowerpharynx cancer). When nutritional support is necessary after the operation, the patient received enteral feeding in addition to oral feeding. Nutritional assessment and volume of oral feeding were evaluated at the out-patient office. When improvement in nutritional status is confirmed, enteral feeding was discontinued, and PEG was removed. Result: As complications of PEG there were 3 cases of peristomal infection at an early stage and 1 case of furyo granulation. Nutritional status was poor in all these patients prior to the operation, and they received enteral nutritional support prior to the operation. 1850Kcal on average was administeredfor 12.5 days on average. Complicationdue to enteral feeding was moderate diarrheaand stomachache in one patient. Enteral feeding was started on 1.8 P.O.D. on average and only electrolytewas administered intravenously. 9 cases that required additional treatment were discharged after 20.3 days on average. The period of home enteral feeding lasted 4.5 months on average. Conclusion: Enteral nutrition using PEG before and after the operationand home care nutritional management of head and neck cancer patients is effective in reducing the burden to patients, the medical expense, resuming social life early, shortening the hospital stay and improving nutritional status and can be a new strategic treatment.
VOLUME 51, NO. 4, PART 2, 2000
Visual analogue scale results, median (inter-quartile range) Gas used CO2 Air p value
Bloating (during)
Bloating (after)
6 (3 - 41) 26 (4 - 55) 0.041
11 (2 - 43) 40 (7 - 61) 0.034
Discomfort (during) 28 (4 - 67) 40 (7 - 61) NS
Discomfort (after) 5 (2 - 21) 17 (5 - 52) 0.016
Mann-Whitney U test. 7027 COMPARISON OF FLEXIBLE SIGMOIDOSCOPIC FINDINGS IN SYMPTOMATIC INDIVIDUALS AND IN THOSE REFERRED FOR ROUTINE CANCER SCREENING. Waqar A. Qureshi, Kamran Ayub, Mary C. Heiser, B. S. Anand, Baylor Coll of Medicine and VA Med Ctr, Houston, TX. Background: Flexible sigmoidoscopy (FS) is frequently used as the initial diagnostic study in patients presenting with symptoms believed to indicate disease of the lower gastrointestinal tract such as iron deficiency anemia, rectal bleeding, and new onset change in bowel habit. However, it is unclear how predictive these symptoms are of colonic pathology. The present study was carried out to examine this issue and to compare the results obtained with those seen in a group of asymptomatic individuals referred for routine screening for colon cancer. Methods: A total of 701 subjects comprising of 577 individuals undergoing screening FS and 124 patients with lower GI symptoms were included in the study. The subjects were examined using a 60 cm flexible sigmoidoscope by a single observer. All subjects had a phosphate enema bowel prep. Results: All study subjects were males. The mean (±SD) age of the asymptomatic group (65±10 years) was significantly greater than symptomatic individuals (61±12 years; p <0.001). The findings at flexible sigmoidoscopy in the two groups is shown in the Table. Abnormal findings were noted in 73% patients with GI symptoms which was significantly greater than that in individuals undergoing screening FS (62%; ). The most common abnormal finding was polyps, seen in 59% of symptomatic subjects compared to 42% in the symptomatic group (p<0.001). No significant difference was observed in the prevalence of colon cancer between the two groups. Comment: The present study shows that although endoscopic abnormalities are seen more frequently in symptomatic individuals, nearly 40% of an unselected asymptomatic veteran population had colonic polyps. Our observations substantiate the findings of previous studies that precancerous lesions occur frequently in our older population and reinforce the concept of routine screening for all individuals over the age of 50 years. Diagnosis Normal Polyps Cancer Hemorroids
AB248
Asymptomatic 213 243 11 13
(37%) (42%) (1.9%) (2.3%)
Symptomatic 19 73 2 7
(15%) (59%) (1.6%) (5.6%)
GASTROINTESTINAL ENDOSCOPY
7028 DIAGNOSTIC AND THERAPEUTIC CAPACITY OF EMERGENCY ENDOSCOPY. Diego Rincon, Cecilia G. Asanza, Javier Vaquero, Maria Escudero, Maria Vega Catalina, Carmen Senent, Paloma Jimenez, Sonia Alonso, Enrique Cos, Pedro Menchen, H G U Gregorio Maranon, Madrid, Spain; Hgu Gregorio Maranon, Madrid, Spain. Background: Although emergency endoscopy plays an important role in diagnosis and management of digestive emergencies, the inmediacy with which this procedure should be performed remains controversial. Aims: 1) Evaluate which percentage of emergency endoscopic procedures gave a main benefit for patient´s prognosis. 2)Analyze the diagnosis capacity of the emergency endoscopy. Methods: Between January and September 1999, 1115 urgent endoscopic procedures were evaluated (1042 gastroscopies and 73 colonoscopies) in 1060 patients (65.1% males, 34.9% females, mean age 60.2 years). Mean time of endoscopy was 5.3 hours after admision, and the distribution in the journey was: morning 25.4%, afternoon and evening 41.7%, and night 32.9%. We defined an exploration as “really urgent” when the endoscopic procedure gave a direct prognosis and therapeutic benefit, on the basis of: diagnosis of variceal bleeding, need of endoscopic therapeutic procedures, foreing bodies removal and caustic injury. Results: the main indication why the endoscopies were asked for were: suspect of upper gastrointestinal bleeding (UGIB, 81.1%), foreing bodies (9.3%), caustic injury (2%), critical lower gastrointestinal bleeding (LGIB, 4%), large bowel volvulus (2%), and ischemic colitis (1.3%). Diagnosis capacity in the UGIB was 95.3%; the only factor related with it was the patient´s age, being older the group not diagnosed (66.1 vs 60.3 years, p<0.05). Diagnosis capacity in the LGIB was 65.5%. 38,86% of the endoscopies carried out fullfiled the criteria of “really urgent”. Conclusions: 1) In our experience, a third of the patients get a benefit of carrying out an early endoscopy. 2) Diagnosis capacity of the emergency in our means is not different from the results of other published series.
p value <0.001 <0.001 ns <0.05
7029 NEW METHOD OF NUTRITIONAL MANAGEMENT FOR HEAD AND NECK CANCER Yutaka Suzuki, Ryuuta Ninomiya, Nobuo Omura, Fumiaki Yano, Nobuyoshi Hanyu, Teruaki Aoki, The Jikei Univ Sch of Medicine, Tokyo, Japan; Jikei Univ Sch of Medicine, Tokyo, Japan. Background: Head and Neck Surgery (tongue, larynx, pharynx and upper jaw) of recent year became possible with the introduction of microscopic surgery and patients QOL has been improved dramatically, the length of hospital stay also shortened. However, generally nutritional support have been managed by ‡@intravenous-hyperalimentation or ‡Aenteral feeding via nasal. In case of IVH, it has prevented early discharge from hospital and early recovery of social activities and in case of enteral feeding via nasal tube, it inflicted pain in patients and prevented early discharge from hospital. As we have adapted percutaneous endoscopic gastrostomy (PEG) to improve nutritional status of patients who are scheduled for surgical operation for head and neck cancer, to start early enteral feeding, and early discharge from hospital, we report the method and the result. Subject and Method: Subjects were 12 patients in Ear and Nose Dept. who have been operated (4 cases of tongue cancer, 3 cases of oral floor cancer, 3 cases of upper jaw and 2 cases of lowerpharynx cancer). When nutritional support is necessary after the operation, the patient received enteral feeding in addition to oral feeding. Nutritional assessment and volume of oral feeding were evaluated at the out-patient office. When improvement in nutritional status is confirmed, enteral feeding was discontinued, and PEG was removed. Result: As complications of PEG there were 3 cases of peristomal infection at an early stage and 1 case of furyo granulation. Nutritional status was poor in all these patients prior to the operation, and they received enteral nutritional support prior to the operation. 1850Kcal on average was administeredfor 12.5 days on average. Complicationdue to enteral feeding was moderate diarrheaand stomachache in one patient. Enteral feeding was started on 1.8 P.O.D. on average and only electrolytewas administered intravenously. 9 cases that required additional treatment were discharged after 20.3 days on average. The period of home enteral feeding lasted 4.5 months on average. Conclusion: Enteral nutrition using PEG before and after the operationand home care nutritional management of head and neck cancer patients is effective in reducing the burden to patients, the medical expense, resuming social life early, shortening the hospital stay and improving nutritional status and can be a new strategic treatment.
VOLUME 51, NO. 4, PART 2, 2000