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P.166 BOWEL PREPARATION FOR COLONOSCOPY IN ELDERLY PATIENTS
Abstracts / Digestive and Liver Disease 42S (2010) S61–S192 P.165 ASSOCIATION BETWEEN UPPER AND LOWER GASTROINTESTINAL TRACT LESIONS L. Elli ∗ ,1 , F. Somalvico 2 , R. Rivolta 1 , F. Fregoni 1 1 U.O.
Gastroenterologia, IRCCS Multimedica, Sesto San Giovanni; IRCCS Multimedica, Sesto San Giovanni
S161
Results: Results were reported in following figure 1. The difference was statistically significative in favour of Group B, both in patients who completed preparation (P<0.001) and in side effects incidence (P<0.003). The efficacy of colonic cleaning (excellent or good, Universal Preparation Assessment Scale) was high in both groups. The number of rescheduled procedures was comparable in two groups.
2 Biostatistica,
Background and aim: Although the wide use of gastrointestinal endoscopy, few is known about possible associations between the disorders of the upper and lower gastrointestinal tracts. Aim of the study was to evaluate possible associations in a cohort of patients underwent to esophagogastroduodenoscopy (EGDS) and colonoscopy. Material and methods: 1018 patients underwent to both EGDS and colonoscopy for the first time and during a short period (maximum 6 months) were retrospectively evaluated for the presence of diseases (acidrelated, precancerous, cancerous, infectious, immunomediated, anatomical) of the upper and lower gastrointestinal tracts. Chi square, Fisher’s Exact test and relative risk (RR) were evaluated for statistical analysis. Results: Out of the 1018 patients (467 males, age ± SD 60.2±14.4), 464 (45.6%) had at least one disease in both the upper and lower gastrointestinal tracts. When a lesion was found in the upper or in the lower gastrointestinal tract the risk to find a second disorder during the other endoscopic investigation is higher than in negative examinations (RR=1.52, CI 95% 1.03-2.24, p=0.032). Barrett esophagus and intestinal metaplasia of the stomach had an increased risk to present polyps of colon (RR 2.97, CI95% 1.17-7.45, p=0.036 and RR 2.22, CI 95% 1.35-3.63, p=0.001 respectively). Helicobacter pylori infection was associated with a decreased risk to present polyps or colon cancer (RR 0.69, CI 95% 0.49-0.99, p=0.044 and RR 0.34, CI 95% 0.19-0.61, p=0.0001). Other statistically significant associations had been found between gastric ulcer and colonic cancer, duodenal ulcer and Crohn’s disease and jatal hernia and colonic diverticula. Conclusions: With all the concerns and limits of a retrospective study, our research evidenced some relevant result: the importance to perform a complete visualization of the upper and lower gastrointestinal tract when precancerous lesions were diagnosed. Although important, the data on Helicobacter pylori infection should be investigated by specifically designed studies. # N. Diagnostic endoscopy - 1. Upper and lower GI
P.166 BOWEL PREPARATION FOR COLONOSCOPY IN ELDERLY PATIENTS M. Cirillo ∗ , N. Gennarelli, A. Calogero, F. Frattolillo, C. Fedele, M. Sannino, F. Piantadosi, M. Nunziante, C. Mattera Policlinico Federico II, Napoli Background and aim: The success and accuracy of colonoscopy are largely dependent on appropriate cleaning of the colon. The bowel preparation with polyethylene-glycol-electrolyte solution (PEG) is commonly used. The colonic cleaning is good but the result is tightly correlated to the solution complete assumption. The need to drink a large volume of fluid (4 litres) over a short period of time the day before colonoscopy, but this case isn’t agreeable. The patients doesn’t often complete the preparation and the poor patient compliance compromises efficacy of colonic cleaning. Besides the intake a large volume of fluid can present side effects as nausea, vomiting, abdominal pain or serious adverse events. These adverse events can be very frequent in elderly patients also in absence of previous cardiovascular or renal diseases. Material and methods: In elderly patients, 65 years or more old, we divided the bowel preparation in two phases, 2 litres/day for two days. We have evaluated the percent of subjects who had completed the preparation, the incidence of side effects, the quality of colonic cleaning, the cecal intubation rate. The patients were divided in two groups: in Group A=116 pts full volume PEG-ELS preparation has been administered the day before colonoscopy. In Group B=321 pts PEG-ELS administration was divided in two days, 2 litres/day before colonoscopy. Patients were questioned before undergoing colonoscopy for side effects and symptoms during bowel preparation.
Fig. 1. Results of study: comparation (%) of two patients groups.
Conclusions: In conclusion a mechanical bowel preparation in elderly patients can be divided in two days before scheduled procedure. This preparation significantly lowers the side effects incidence as nausea, vomiting, abdominal pain and it don’t reduces the colonic cleaning level. # N. Diagnostic endoscopy - 1. Upper and lower GI
P.167 COMPARISON AMONG THREE DIFFERENT INTESTINAL PREPARATIONS IN SCREENING COLONOSCOPIES, WITH PARTICULAR REGARD TO ACCEPTABILITY BY THE PATIENTS R. Fasoli ∗ ,1 , M. Fortuna 1 , K. Faitini 1 , G. Miori 1 , I. Floriani 2 , M. Alessandrini 1 , C. De Bei 1 , G. de Pretis 1 1 Gastrointestinal
Unit, Ospedale Santa Chiara, Trento; 2 Istituto Mario Negri,
Milano Background and aim: Intestinal preparation is a crucial factor in quality assurance of screening colonoscopies, as it permits – if adequate – to properly visualize the colonic mucosa, particularly in the right colon, where a missed lesion might have ominous consequences in the future of the screened subject. The commitment of the patient to the proper assumption of the product depends on ease of preparation, palatability, timing and – last but not least – tolerance. Material and methods: We have recently completed a randomized, singleblind clinical trial aimed at comparing three different intestinal preparations for colonoscopy of faecal occult blood test-positive subjects: standard dose (4 liters) polyethilene-glycole (PEG) (Selg, Promefarm), reduced dose (2 liter) PEG with ascorbic acid (Moviprep, Norgine), and sodium phosphate (Na-P) (Phospholax, Sofar). Results: Out of 150 consecutive patients, referring to our unit for a screening colonoscopy, 149 considered eligible were included in the trial. Intestinal preparation was blindly classified by the endoscopic operator according to the Aronchick score. Statistical analysis was carried out by means of chi-square test for trend, adjusted for sex in order to make allowance for a different sex distribution in the 3 groups. No statistically significant differences have been detected as regarded the patient’s perception of the cleansing regimen (palatability, discomfort, secondary symptoms, ease of preparation). Coming to the registered scores in terms of colonic cleansing, standard-dose PEG performed significantly better than Na-P (p=0.003), whereas the superiority of low-dose PEG over Na-P just lacked significant power (p=0.066). No statistically significant differences were detected as regards the other comparisons. Conclusions: Reduced dose PEG compared favourably - in this study - with the standard dose product, both in terms of patient-related factors (preparation, palatability, tolerance) and in cleansing efficacy. Although well tolerated, Na-P efficacy proved to be less efficacious than PEG. # N. Diagnostic endoscopy - 1. Upper and lower GI
Gastroenterologia, IRCCS Multimedica, Sesto San Giovanni; IRCCS Multimedica, Sesto San Giovanni
S161
Results: Results were reported in following figure 1. The difference was statistically significative in favour of Group B, both in patients who completed preparation (P<0.001) and in side effects incidence (P<0.003). The efficacy of colonic cleaning (excellent or good, Universal Preparation Assessment Scale) was high in both groups. The number of rescheduled procedures was comparable in two groups.
2 Biostatistica,
Background and aim: Although the wide use of gastrointestinal endoscopy, few is known about possible associations between the disorders of the upper and lower gastrointestinal tracts. Aim of the study was to evaluate possible associations in a cohort of patients underwent to esophagogastroduodenoscopy (EGDS) and colonoscopy. Material and methods: 1018 patients underwent to both EGDS and colonoscopy for the first time and during a short period (maximum 6 months) were retrospectively evaluated for the presence of diseases (acidrelated, precancerous, cancerous, infectious, immunomediated, anatomical) of the upper and lower gastrointestinal tracts. Chi square, Fisher’s Exact test and relative risk (RR) were evaluated for statistical analysis. Results: Out of the 1018 patients (467 males, age ± SD 60.2±14.4), 464 (45.6%) had at least one disease in both the upper and lower gastrointestinal tracts. When a lesion was found in the upper or in the lower gastrointestinal tract the risk to find a second disorder during the other endoscopic investigation is higher than in negative examinations (RR=1.52, CI 95% 1.03-2.24, p=0.032). Barrett esophagus and intestinal metaplasia of the stomach had an increased risk to present polyps of colon (RR 2.97, CI95% 1.17-7.45, p=0.036 and RR 2.22, CI 95% 1.35-3.63, p=0.001 respectively). Helicobacter pylori infection was associated with a decreased risk to present polyps or colon cancer (RR 0.69, CI 95% 0.49-0.99, p=0.044 and RR 0.34, CI 95% 0.19-0.61, p=0.0001). Other statistically significant associations had been found between gastric ulcer and colonic cancer, duodenal ulcer and Crohn’s disease and jatal hernia and colonic diverticula. Conclusions: With all the concerns and limits of a retrospective study, our research evidenced some relevant result: the importance to perform a complete visualization of the upper and lower gastrointestinal tract when precancerous lesions were diagnosed. Although important, the data on Helicobacter pylori infection should be investigated by specifically designed studies. # N. Diagnostic endoscopy - 1. Upper and lower GI
P.166 BOWEL PREPARATION FOR COLONOSCOPY IN ELDERLY PATIENTS M. Cirillo ∗ , N. Gennarelli, A. Calogero, F. Frattolillo, C. Fedele, M. Sannino, F. Piantadosi, M. Nunziante, C. Mattera Policlinico Federico II, Napoli Background and aim: The success and accuracy of colonoscopy are largely dependent on appropriate cleaning of the colon. The bowel preparation with polyethylene-glycol-electrolyte solution (PEG) is commonly used. The colonic cleaning is good but the result is tightly correlated to the solution complete assumption. The need to drink a large volume of fluid (4 litres) over a short period of time the day before colonoscopy, but this case isn’t agreeable. The patients doesn’t often complete the preparation and the poor patient compliance compromises efficacy of colonic cleaning. Besides the intake a large volume of fluid can present side effects as nausea, vomiting, abdominal pain or serious adverse events. These adverse events can be very frequent in elderly patients also in absence of previous cardiovascular or renal diseases. Material and methods: In elderly patients, 65 years or more old, we divided the bowel preparation in two phases, 2 litres/day for two days. We have evaluated the percent of subjects who had completed the preparation, the incidence of side effects, the quality of colonic cleaning, the cecal intubation rate. The patients were divided in two groups: in Group A=116 pts full volume PEG-ELS preparation has been administered the day before colonoscopy. In Group B=321 pts PEG-ELS administration was divided in two days, 2 litres/day before colonoscopy. Patients were questioned before undergoing colonoscopy for side effects and symptoms during bowel preparation.
Fig. 1. Results of study: comparation (%) of two patients groups.
Conclusions: In conclusion a mechanical bowel preparation in elderly patients can be divided in two days before scheduled procedure. This preparation significantly lowers the side effects incidence as nausea, vomiting, abdominal pain and it don’t reduces the colonic cleaning level. # N. Diagnostic endoscopy - 1. Upper and lower GI
P.167 COMPARISON AMONG THREE DIFFERENT INTESTINAL PREPARATIONS IN SCREENING COLONOSCOPIES, WITH PARTICULAR REGARD TO ACCEPTABILITY BY THE PATIENTS R. Fasoli ∗ ,1 , M. Fortuna 1 , K. Faitini 1 , G. Miori 1 , I. Floriani 2 , M. Alessandrini 1 , C. De Bei 1 , G. de Pretis 1 1 Gastrointestinal
Unit, Ospedale Santa Chiara, Trento; 2 Istituto Mario Negri,
Milano Background and aim: Intestinal preparation is a crucial factor in quality assurance of screening colonoscopies, as it permits – if adequate – to properly visualize the colonic mucosa, particularly in the right colon, where a missed lesion might have ominous consequences in the future of the screened subject. The commitment of the patient to the proper assumption of the product depends on ease of preparation, palatability, timing and – last but not least – tolerance. Material and methods: We have recently completed a randomized, singleblind clinical trial aimed at comparing three different intestinal preparations for colonoscopy of faecal occult blood test-positive subjects: standard dose (4 liters) polyethilene-glycole (PEG) (Selg, Promefarm), reduced dose (2 liter) PEG with ascorbic acid (Moviprep, Norgine), and sodium phosphate (Na-P) (Phospholax, Sofar). Results: Out of 150 consecutive patients, referring to our unit for a screening colonoscopy, 149 considered eligible were included in the trial. Intestinal preparation was blindly classified by the endoscopic operator according to the Aronchick score. Statistical analysis was carried out by means of chi-square test for trend, adjusted for sex in order to make allowance for a different sex distribution in the 3 groups. No statistically significant differences have been detected as regarded the patient’s perception of the cleansing regimen (palatability, discomfort, secondary symptoms, ease of preparation). Coming to the registered scores in terms of colonic cleansing, standard-dose PEG performed significantly better than Na-P (p=0.003), whereas the superiority of low-dose PEG over Na-P just lacked significant power (p=0.066). No statistically significant differences were detected as regards the other comparisons. Conclusions: Reduced dose PEG compared favourably - in this study - with the standard dose product, both in terms of patient-related factors (preparation, palatability, tolerance) and in cleansing efficacy. Although well tolerated, Na-P efficacy proved to be less efficacious than PEG. # N. Diagnostic endoscopy - 1. Upper and lower GI