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Su1544 Obesity and Caecum Intubation Time- Is It a Paradox?
Abstracts
used SCC and 68 had used HCP. 50 patients did not have any follow-up of blood work up. Out of the 83 patients that had a follow-up blood work up 39 had used SCC and 44 had used HCP. An Independent- Samples Mann-Whitney U test was carried out which showed that there was no significant difference (pZ0.739) in between the mean of change in sCr concentration (-0.02 0.19 vs -0.01 0.21) and change in GFR (1.9 12.8 vs 0.5 16.5). There was also no significant difference in the baseline and follow-up sCr and GFR in between the two groups. i.e both the groups had a similar baseline and a similar follow-up renal function test. Conclusion: Our study concluded that SCC has no significant effect on the renal function - ie. sCr and GFR of patients did not change when followed up over a period of time. References: 1. Arya V et al. Rapid colonoscopy preparation using bolus lukewarm saline combined with sequential posture changes: a randomized controlled trial. Dig Dis Sci. 2013 Aug; 58(8):2156-66. 2. Abaskharoun R, et al. Changes in renal function following administration of oral sodium phosphate or polyethylene glycol for colon cleansing before colonoscopy. Can J Gastroenterol. 2007 Apr;21(4):227-31. 3. Levey AS et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009 May 5; 150(9):604-12. Erratum in: Ann Intern Med. 2011 Sep 20; 155(6):408.
Renal function of all patients at baseline and at follow-up measurement (n[83) Baseline creatinine, (mg/dl) Follow-up creatinine, (mg/dl) Baseline GFR, (ml/min) Follow-up GFR, (ml/min) Change in creatinine conc. (mg/dl) Change in GFR, (ml/min)
Preparation
n
Mean ± SD
p
SCC HCP SCC HCP SCC HCP SCC HCP SCC HCP SCC HCP
39 44 39 44 39 44 39 44 39 44 39 44
0.82 0.17 0.85 0.19 0.82 0.17 0.84 0.15 97.4 14.5 95.6 21.3 95.5 14.6 95.1 14.4 -0.02 0.19 -0.01 0.21 1.9 12.8 0.5 16.5
0.306 0.443 0.267 0.820 0.739 0.632
Su1544 Obesity and Caecum Intubation Time- Is It a Paradox? Deepanshu Jain*, Abhinav Goyal, Talal Alnabelsi, Ramzi H. Mulki, Jorge Uribe Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA Background: Obesity is a much debatable factor with conflicting evidence in relation to its association with caecum intubation rates and caecum intubation time during colonoscopy. We have designed our study to better define this association by controlling all other known confounding factors. Method- The retrospective study involved chart review of 4,494 subjects undergoing outpatient colonoscopy over a span of 18 months. Subjects with poor bowel preparation /failure of caecum intubation/ past history of IBD/ colectomy/ abdominal surgery/ personal or family history of colon cancer/ procedures done by fellow were excluded. The study group was divided into male and female sub-groups. Each gender group was further categorised based on body mass index (BMI) into three categories- I (Non-Obese, BMI ! 24.9), II (Overweight, BMI- 25 to 29.9), III (Obese, BMI- OZ30). Colonoscopy procedure reports were used to collect data on caecum intubation (CI) time. Mean CI time was them computed and statistical significance was determined using two way T test. Results: 926 subjects, with a mean age of 58.8 years satisfied the inclusion criteria. The study population composed of 47.7% females and 52.3% male subjects. Distribution of cases across day was non-uniform with 57.8% procedures done in morning session and 42.2% in the afternoon session. Mean CI time for the study group was 15.7 7.9 minutes (min). Mean CI time for male group (15.9 7.9 min) was minimally higher than female group (15.5 7.9 min). Mean CI among female category I, II and III was 14.4 ( 6.5) min, 15.5 (8.3) min and 16.2 (8.1) min respectively. Mean CI time for male category I, II and III was 16.3 (8.9) min, 15.9 (8.0) min and 15.6 (7.2) min respectively. Conclusions: CI among overweight female subjects is difficult in comparison to non-obese female subjects (p value ! 0.01). Our study also highlights the positive association between BMI and CI time among female group in contrast to negative association between BMI and CI time among male group. The study findings have important implication in changing endoscopist’s perception of difficult colonoscopy among obese patients.
AB322 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
Su1545 A Multi-Cultural Approach to Dietary Restrictions in the Days Preceding Colonoscopy Kristin L. Macarthur*1, Anna Leszczynski2, Paula A. Quatromoni3, Brian C. Jacobson1 1 Gastroenterology, Boston Medical Center, Boston, MA; 2Internal Medicine, Boston Medical Center, Boston, MA; 3Health Sciences, Boston University School of Medicine, Boston, MA Background: Great variation exists in dietary restrictions prior to colonoscopy reflecting limited evidence for how specific foods effect bowel preparation. We previously demonstrated an association between dietary insoluble fiber, starch and refined grains and bowel preparation. Nonetheless, without an appreciation of foods patients prefer to consume, broad dietary restrictions prior to colonoscopy may lead to decreased compliance and lower patient satisfaction. We sought to characterize dietary preferences among a diverse population to generate evidence for a culturally sensitive approach to bowel preparation instructions. Methods: We performed standardized dietary interviews with 74 patients or their family members in our endoscopy unit. We sought a minimum of 10 unrelated individuals from each of 6 national or ethnic backgrounds including US-born White (nZ19, 26%), US-born African American (nZ11, 15%), Haitian (nZ10, 14%), Cape Verdean (nZ10, 14%), Caribbean/Central or South American Latino (nZ14, 19%), and Southeast Asian (nZ10, 14%). We elicited information concerning commonly consumed vegetables, fruits, fish, meat, nuts, and grains, asking which foods would be most difficult to temporarily eliminate from one’s diet. Soluble and insoluble fiber content of reported foods and portion sizes were computed using the Nutrition Data System for Research (NDSR) database. We used the NIH low residue diet to classify foods accordingly. We also asked subjects what they would consume if told to consume only clear liquids. Results: Average subject age was 46 and 58% were male. Subjects included 29 (39%) colonoscopy patients and 45 (61%) patient family members. Only 46% were US born. The most commonly consumed foods among all cultural groups were white rice (53%), chicken (46%), beef (24%) and beans (22%). Subjects also reported these same foods would be most difficult to temporarily eliminate from their diet. Table 1 shows commonly reported foods, their fiber content, and whether they are allowed on a low residue diet. Only 72% of subjects demonstrated correct understanding of a clear liquid diet. Patients were less likely than family members to understand what “clear liquids” meant (62% vs 38%, p Z0.01). Furthermore, 39% of subjects demonstrated incorrect understanding of “clear broth”. Subjects offered cultural-specific terms to convey “clear broth” including clear soup, bouillon and consume. Conclusion: We observed several commonly preferred foods among a culturally-diverse population that met criteria for a low residue diet (Table 1). These foods may be suitable prior to colonoscopy without affecting bowel cleanliness. If requiring “clear liquids”, very specific culturally-sensitive examples of what is acceptable should also be included in bowel preparation instructions.
Table 1. Dietary preferences and corresponding fiber content Commonly Consumed Foods (by O15% of respondents)
Soluble Fiber (gm)
Insoluble Fiber (gm)
Allowed on a Low Residue Diet?
Vegetables (1/2 cup cooked; 1 cup raw) Carrots, cooked, sliced 0.491 1.849
Y
Lettuce, raw
0.068
0.616
Y
Green beans, cooked
0.400
1.600
Y
Broccoli, cooked, chopped Corn, cooked Tomato, raw, chopped
0.304
2.604
N
0.124 0.117
1.856 0.963
N N
Fruit (1 medium piece; or 1 cup) Banana, 1 med. 0.991 2.077 Peach, 1 med. 1.035 1.215 Watermelon, 1 cup 0.198 0.410 Apple, 1 med. 1.329 3.039 Orange, 1 med. 1.795 1.297 Grapes, 1 cup 0.000 1.359 Strawberries, 1 cup 0.662 2.218 Grains and Legumes (1/2 cup cooked) White rice, cooked 0.000 0.269 Beans, cooked 0.204 5.372
Low Residue Diet Caveats Only if well cooked or canned OK when consumed raw Only if well cooked or canned
No tomato sauce either
Y Y Y N N N N
Only if very ripe Only if very ripe Only if very ripe Only as applesauce
Y N
No brown rice No beans, peas or tofu
www.giejournal.org
used SCC and 68 had used HCP. 50 patients did not have any follow-up of blood work up. Out of the 83 patients that had a follow-up blood work up 39 had used SCC and 44 had used HCP. An Independent- Samples Mann-Whitney U test was carried out which showed that there was no significant difference (pZ0.739) in between the mean of change in sCr concentration (-0.02 0.19 vs -0.01 0.21) and change in GFR (1.9 12.8 vs 0.5 16.5). There was also no significant difference in the baseline and follow-up sCr and GFR in between the two groups. i.e both the groups had a similar baseline and a similar follow-up renal function test. Conclusion: Our study concluded that SCC has no significant effect on the renal function - ie. sCr and GFR of patients did not change when followed up over a period of time. References: 1. Arya V et al. Rapid colonoscopy preparation using bolus lukewarm saline combined with sequential posture changes: a randomized controlled trial. Dig Dis Sci. 2013 Aug; 58(8):2156-66. 2. Abaskharoun R, et al. Changes in renal function following administration of oral sodium phosphate or polyethylene glycol for colon cleansing before colonoscopy. Can J Gastroenterol. 2007 Apr;21(4):227-31. 3. Levey AS et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009 May 5; 150(9):604-12. Erratum in: Ann Intern Med. 2011 Sep 20; 155(6):408.
Renal function of all patients at baseline and at follow-up measurement (n[83) Baseline creatinine, (mg/dl) Follow-up creatinine, (mg/dl) Baseline GFR, (ml/min) Follow-up GFR, (ml/min) Change in creatinine conc. (mg/dl) Change in GFR, (ml/min)
Preparation
n
Mean ± SD
p
SCC HCP SCC HCP SCC HCP SCC HCP SCC HCP SCC HCP
39 44 39 44 39 44 39 44 39 44 39 44
0.82 0.17 0.85 0.19 0.82 0.17 0.84 0.15 97.4 14.5 95.6 21.3 95.5 14.6 95.1 14.4 -0.02 0.19 -0.01 0.21 1.9 12.8 0.5 16.5
0.306 0.443 0.267 0.820 0.739 0.632
Su1544 Obesity and Caecum Intubation Time- Is It a Paradox? Deepanshu Jain*, Abhinav Goyal, Talal Alnabelsi, Ramzi H. Mulki, Jorge Uribe Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA Background: Obesity is a much debatable factor with conflicting evidence in relation to its association with caecum intubation rates and caecum intubation time during colonoscopy. We have designed our study to better define this association by controlling all other known confounding factors. Method- The retrospective study involved chart review of 4,494 subjects undergoing outpatient colonoscopy over a span of 18 months. Subjects with poor bowel preparation /failure of caecum intubation/ past history of IBD/ colectomy/ abdominal surgery/ personal or family history of colon cancer/ procedures done by fellow were excluded. The study group was divided into male and female sub-groups. Each gender group was further categorised based on body mass index (BMI) into three categories- I (Non-Obese, BMI ! 24.9), II (Overweight, BMI- 25 to 29.9), III (Obese, BMI- OZ30). Colonoscopy procedure reports were used to collect data on caecum intubation (CI) time. Mean CI time was them computed and statistical significance was determined using two way T test. Results: 926 subjects, with a mean age of 58.8 years satisfied the inclusion criteria. The study population composed of 47.7% females and 52.3% male subjects. Distribution of cases across day was non-uniform with 57.8% procedures done in morning session and 42.2% in the afternoon session. Mean CI time for the study group was 15.7 7.9 minutes (min). Mean CI time for male group (15.9 7.9 min) was minimally higher than female group (15.5 7.9 min). Mean CI among female category I, II and III was 14.4 ( 6.5) min, 15.5 (8.3) min and 16.2 (8.1) min respectively. Mean CI time for male category I, II and III was 16.3 (8.9) min, 15.9 (8.0) min and 15.6 (7.2) min respectively. Conclusions: CI among overweight female subjects is difficult in comparison to non-obese female subjects (p value ! 0.01). Our study also highlights the positive association between BMI and CI time among female group in contrast to negative association between BMI and CI time among male group. The study findings have important implication in changing endoscopist’s perception of difficult colonoscopy among obese patients.
AB322 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
Su1545 A Multi-Cultural Approach to Dietary Restrictions in the Days Preceding Colonoscopy Kristin L. Macarthur*1, Anna Leszczynski2, Paula A. Quatromoni3, Brian C. Jacobson1 1 Gastroenterology, Boston Medical Center, Boston, MA; 2Internal Medicine, Boston Medical Center, Boston, MA; 3Health Sciences, Boston University School of Medicine, Boston, MA Background: Great variation exists in dietary restrictions prior to colonoscopy reflecting limited evidence for how specific foods effect bowel preparation. We previously demonstrated an association between dietary insoluble fiber, starch and refined grains and bowel preparation. Nonetheless, without an appreciation of foods patients prefer to consume, broad dietary restrictions prior to colonoscopy may lead to decreased compliance and lower patient satisfaction. We sought to characterize dietary preferences among a diverse population to generate evidence for a culturally sensitive approach to bowel preparation instructions. Methods: We performed standardized dietary interviews with 74 patients or their family members in our endoscopy unit. We sought a minimum of 10 unrelated individuals from each of 6 national or ethnic backgrounds including US-born White (nZ19, 26%), US-born African American (nZ11, 15%), Haitian (nZ10, 14%), Cape Verdean (nZ10, 14%), Caribbean/Central or South American Latino (nZ14, 19%), and Southeast Asian (nZ10, 14%). We elicited information concerning commonly consumed vegetables, fruits, fish, meat, nuts, and grains, asking which foods would be most difficult to temporarily eliminate from one’s diet. Soluble and insoluble fiber content of reported foods and portion sizes were computed using the Nutrition Data System for Research (NDSR) database. We used the NIH low residue diet to classify foods accordingly. We also asked subjects what they would consume if told to consume only clear liquids. Results: Average subject age was 46 and 58% were male. Subjects included 29 (39%) colonoscopy patients and 45 (61%) patient family members. Only 46% were US born. The most commonly consumed foods among all cultural groups were white rice (53%), chicken (46%), beef (24%) and beans (22%). Subjects also reported these same foods would be most difficult to temporarily eliminate from their diet. Table 1 shows commonly reported foods, their fiber content, and whether they are allowed on a low residue diet. Only 72% of subjects demonstrated correct understanding of a clear liquid diet. Patients were less likely than family members to understand what “clear liquids” meant (62% vs 38%, p Z0.01). Furthermore, 39% of subjects demonstrated incorrect understanding of “clear broth”. Subjects offered cultural-specific terms to convey “clear broth” including clear soup, bouillon and consume. Conclusion: We observed several commonly preferred foods among a culturally-diverse population that met criteria for a low residue diet (Table 1). These foods may be suitable prior to colonoscopy without affecting bowel cleanliness. If requiring “clear liquids”, very specific culturally-sensitive examples of what is acceptable should also be included in bowel preparation instructions.
Table 1. Dietary preferences and corresponding fiber content Commonly Consumed Foods (by O15% of respondents)
Soluble Fiber (gm)
Insoluble Fiber (gm)
Allowed on a Low Residue Diet?
Vegetables (1/2 cup cooked; 1 cup raw) Carrots, cooked, sliced 0.491 1.849
Y
Lettuce, raw
0.068
0.616
Y
Green beans, cooked
0.400
1.600
Y
Broccoli, cooked, chopped Corn, cooked Tomato, raw, chopped
0.304
2.604
N
0.124 0.117
1.856 0.963
N N
Fruit (1 medium piece; or 1 cup) Banana, 1 med. 0.991 2.077 Peach, 1 med. 1.035 1.215 Watermelon, 1 cup 0.198 0.410 Apple, 1 med. 1.329 3.039 Orange, 1 med. 1.795 1.297 Grapes, 1 cup 0.000 1.359 Strawberries, 1 cup 0.662 2.218 Grains and Legumes (1/2 cup cooked) White rice, cooked 0.000 0.269 Beans, cooked 0.204 5.372
Low Residue Diet Caveats Only if well cooked or canned OK when consumed raw Only if well cooked or canned
No tomato sauce either
Y Y Y N N N N
Only if very ripe Only if very ripe Only if very ripe Only as applesauce
Y N
No brown rice No beans, peas or tofu
www.giejournal.org