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He B, Xin Y, Li R, Lin FC, Zhang GM, Zhu HJ. Bowel preparation experiences and needs before follow-up colonoscopy in older adult postoperative colorectal cancer patients: A qualitative study. World J Gastrointest Surg 2024; 16:2968-2978. [PMID: 39351553 PMCID: PMC11438796 DOI: 10.4240/wjgs.v16.i9.2968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 09/18/2024] Open
Abstract
BACKGROUND The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation, which in turn affects the quality of the colonoscopy. Colonoscopy is an essential procedure for postoperative follow-up monitoring of colorectal cancer (CRC) patients. Previous studies have shown that advanced age and a history of colorectal resection are both risk factors for inadequate bowel preparation. However, little attention has been paid to the bowel preparation experiences and needs of predominantly older adult postoperative CRC patients. AIM To explore the experiences and needs of older adult postoperative CRC patients during bowel preparation for follow-up colonoscopy. METHODS Fifteen older adult postoperative CRC patients who underwent follow-up colonoscopy at a tertiary hospital in Shanghai were selected using purposive sampling from August 2023 to November 2023. The phenomenological method in qualitative research was employed to construct an interview outline and conduct semi-structured interviews with the patients. Colaizzi's seven-step analysis was utilized to organize, code, categorize, summarize, and verify the interview data. RESULTS The results of this study were summarized into four themes and eight sub-themes: (1) Inadequate knowledge about bowel preparation; (2) Decreased physiological comfort during bowel preparation (gastrointestinal discomfort and sleep deprivation caused by bowel cleansing agents, and hunger caused by dietary restrictions; (3) Psychological changes during different stages of bowel preparation (pre-preparation: Fear and resistance due to previous experiences; during preparation: Irritation and helplessness caused by taking bowel cleansing agents, and post-preparation: Anxiety and worry while waiting for the colonoscopy); and (4) Needs related to bowel preparation (detailed instructions from healthcare professionals; more ideal bowel cleansing agents; and shortened waiting times for colonoscopy). CONCLUSION Older adult postoperative CRC patients' knowledge of bowel preparation is not adequate, and they may encounter numerous difficulties and challenges during the process. Healthcare professionals should place great emphasis on providing instruction for their bowel preparation.
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Affiliation(s)
- Bin He
- Wuxi Medical College, The Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Yi Xin
- Wuxi Medical College, The Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Rui Li
- Department of Nursing, The Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200335, China
| | - Fu-Cai Lin
- Wuxi Medical College, The Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Guang-Ming Zhang
- Department of Anesthesiology, The Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200335, China
| | - Hai-Jing Zhu
- Department of Endoscopy, The Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200335, China
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Di Leo M, Iannone A, Arena M, Losurdo G, Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A. Novel frontiers of agents for bowel cleansing for colonoscopy. World J Gastroenterol 2021; 27:7748-7770. [PMID: 34963739 PMCID: PMC8661374 DOI: 10.3748/wjg.v27.i45.7748] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’ acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’ tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.
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Affiliation(s)
- Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Monica Arena
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Pierluigi Consolo
- Unit of Digestive Endoscopy, University of Messina, Hospital "G. Martino", Messina 98121, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Yoo IK, Jeen YT, Choi SJ, Choi HS, Keum B, Kim ES, Chun HJ, Lee HS, Kim CD. Evaluation of bowel preparation quality in patients with a history of colorectal resection. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:278-283. [PMID: 30666966 DOI: 10.5152/tjg.2018.17517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Suboptimal bowel function can negatively affect colon cleansing for colonoscopy after surgery. Very few studies have compared the relationship between the colorectal resection and the bowel preparation quality. We postulated that the colon cleansing quality in patients with a history of colorectal surgery might not be inferior to that of patients with no resection history. MATERIALS AND METHODS Overall, 200 patients were enrolled in the study and distributed into two groups: the resection group (RG) and the control group. The surgical maneuvers were classified as right colectomy, left colectomy, and rectosigmoidectomy. The bowel preparation was performed using 2-L low-volume or 4-L high-volume regimens, and the preparation quality was evaluated using the modified Boston Bowel Preparation Scale (BBPS). RESULTS There were no significant differences in achieving adequate cleansing observed between the RG and the control group (modified BBPS of 6-9; 88% vs. 88%). According to the logistic regression analysis of the RG, patients with a left colon resection had an odds ratio (OR) of 0.27 (p=0.003) for achieving a successful cleansing, and the low-volume preparation (OR=3.092, p=0.023) was the main predictor of a successful cleansing procedure. However, a longer time between colonoscopy and surgery was not related to unsuccessful bowel cleansing. CONCLUSION Our study demonstrates that a history of colorectal surgery is not a risk factor for inadequate colon cleansing.
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Affiliation(s)
- In Kyung Yoo
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong Ji Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Republic of Korea
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Liu Z, Li YY, Luo XT, Guo CG, Zhang MM, Li Z, Li LX, Zhang Y, Li YQ. Split-dose 4-L polyethylene glycol regimen for patients with previous colorectal surgery in bowel preparation before colonoscopy: A randomized, controlled, single-blind study. J Dig Dis 2018; 19:359-368. [PMID: 29790278 DOI: 10.1111/1751-2980.12608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/11/2018] [Accepted: 05/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to investigate the efficacy of a split-dose 4-L polyethylene glycol (PEG) regimen for the quality of bowel preparation in Asian patients with previous colorectal surgery for colorectal cancer (CRC). METHODS This was a prospective, single-center, randomized controlled, endoscopist-blinded study. Patients with previous colorectal surgery for CRC were randomly allocated to a routine, morning-only 2-L PEG (2-MO) group or a split-dose 4-L PEG (4-SD) group. The primary outcome was a successful bowel preparation rate. Secondary outcomes were polyp detection rate (PDR), adenoma detection rate (ADR), patient compliance, satisfaction, tolerance, willingness to repeat the preparation and difficulty of the bowel preparation process. RESULTS In total, 187 patients were included (93 in the 2-MO group, 94 in the 4-SD group) in this study. The rate of successful bowel preparation in the 4-SD group was higher than in the 2-MO group (89.4% vs 66.7%, P < 0.001) in an intention-to-treat analysis according to the Aronchick score. Patients' satisfaction with the bowel preparation process in the 4-SD group was superior to that in the 2-MO group (93.4% vs 82.2%, P = 0.021). No significant differences were detected in PDR, ADR, patient compliance, tolerance, willingness to repeat the preparation or difficulty of the bowel preparation process. CONCLUSIONS The 4-SD PEG regimen was superior to a routine, morning-only 2-L PEG preparation for bowel preparation in an Asian population with previous colorectal surgery.
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Affiliation(s)
- Zhu Liu
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Yue Yue Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Xue Ting Luo
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Chuan Guo Guo
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Ming Ming Zhang
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Zhen Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Li Xiang Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Yan Zhang
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Yan Qing Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
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Grimaldi G, Eberspacher C, Romani AM, Merletti D, Maturo A, Pontone S, Pironi D. Modified transverse coloplasty pouch: new reconstruction techniques after total mesorectal excision. Our experience. G Chir 2018; 38:285-290. [PMID: 29442059 DOI: 10.11138/gchir/2017.38.6.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The incidence of rectal cancer continues to rise. The functional results after complete Total Mesorectal Excision (TME) depend on the segment of colon used for reconstruction of colonic continuity and the form, the volume and the functional proprieties of the "neorectum". The aim of our study is evaluate the efficacy of our Modified Transverse Coloplasty Pouch (MTCP) after the treatment of low rectal cancer in terms of functional outcomes and quality of life. PATIENTS AND METHODS The study included 136 patients, underwent TME from January 2007 to December 2016 with diagnosis of extraperitoneal carcinoma of the rectum. The average distance of the tumor from the dentate line was 5.6 cm. Our follow-up protocol included functional outcome evaluation at 7th post-operative day (POD), 2nd month, and 6th month after the surgery. RESULTS All patients (M/F 84/52) underwent anterior rectal resection (TME) with MTCP. Frequency of bowel movements per 24 hours in the studied patients compared at 7th POD, 2 months, and 6 months. Since the first post-operative weeks there is an encouraging reduction of the frequency of bowel movements. CONCLUSION Modified Transverse Coloplasty Pouch (MTCP) had better functional results and quality of life compared to patients with a Colonic J Pouch (CJP) and traditional Transverse Coloplasty Pouch (TCP).
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Pontone S, Palma R, Panetta C, Eberspacher C, Angelini R, Pironi D, Filippini A, Pontone P. Polyethylene glycol-based bowel preparation before colonoscopy for selected inpatients: A pilot study. J Dig Dis 2018; 19:40-47. [PMID: 29266839 DOI: 10.1111/1751-2980.12571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the impact of a new same-day, low-dose 1-L polyethylene glycol-based (1-L PEG) bowel preparation on the diagnostic rating of selected hospitalized patients and its tolerability, with risk factors for inadequate bowel preparation. METHODS A single-center prospective pilot study was conducted with hospitalized patients scheduled for colonoscopy, presenting risk factors for poor bowel preparation, such as bleeding or subocclusive symptoms. The included patients were randomly divided in two groups, which received either a same-day 1-L PEG (group A) or a split-dose 4-L PEG (group B), and performed a colonoscopy within 4 h of the last dose. RESULTS In all, 44 inpatients [27 males; mean age 63.5 years (range 20-94 years)] were enrolled. Optimal bowel cleansing was reached in 64% and 55% (P = 0.64) of patients in groups A and B, respectively. The adenoma detection rate was 14% (group A) and 18% (group B) (P = 0.34). A valid diagnosis was reached in 38 (86%) of 44 patients (21 in group A and 17 in group B) after a mean hospitalization of 3 days for group A and 6 days for group B (P = 0.04). CONCLUSIONS Our data support the conclusion that the schedule protocol proposed in this study enables a clear diagnosis in most of the inpatients at high risk of poor bowel preparation and no statistical differences were found between the two groups in terms of successful bowel cleansing achieved. Therefore, the same-day, low-dose 1-L PEG bowel preparation could be introduced for selected inpatients.
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Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Rossella Palma
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Panetta
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Chiara Eberspacher
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Rita Angelini
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Sulz MC, Kröger A, Prakash M, Manser CN, Heinrich H, Misselwitz B. Meta-Analysis of the Effect of Bowel Preparation on Adenoma Detection: Early Adenomas Affected Stronger than Advanced Adenomas. PLoS One 2016; 11:e0154149. [PMID: 27257916 PMCID: PMC4892520 DOI: 10.1371/journal.pone.0154149] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/10/2016] [Indexed: 02/06/2023] Open
Abstract
Background and Aims Low-quality bowel preparation reduces efficacy of colonoscopy. We aimed to summarize effects of bowel preparation on detection of adenomas, advanced adenomas and colorectal cancer. Methods A systematic literature search was performed regarding detection of colonic lesions after normal and low-quality bowel preparation. Reported bowel preparation quality was transformed to the Aronchick scale with its qualities “excellent”, “good”, “fair”, “poor”, and “insufficient” or “optimal” (good/excellent), “suboptimal” (fair/poor/insufficient), “adequate” (good/excellent/fair) and “inadequate” (poor/insufficient). We identified two types of studies: i) Comparative studies, directly comparing lesion detection according to bowel preparation quality, and ii) repeat colonoscopy studies, reporting results of a second colonoscopy after previous low-quality preparation. Results The detection of early adenomas was reduced with inadequate vs. adequate bowel preparation (Odds Ratio (OR) 0.53, CI: 0.46–0.62, p<0.001). The advanced adenomas were affected less in comparison (0.74, CI: 0.62–0.87, p<0.001). The large number of subjects considered in the present meta-analysis resulted in smaller confidence intervals compared to earlier studies. Classifying the bowel-preparation quality as suboptimal vs. optimal led to the same qualitative conclusion (OR: 0.81, CI: 0.74–0.89, p<0.001 for early adenomas, OR: 0.94, CI: 0.87–1.01, n.s. for advanced adenomas). Bowel preparation was equally important for right-sided/ flat/ serrated vs. other lesions in most observational studies but more relevant in some repeat colonoscopy studies; data regarding carcinoma detection were insufficient. Conclusion Inadequate bowel preparation affects detection of early colonic lesions stronger than advanced lesions.
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Affiliation(s)
- Michael C. Sulz
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Arne Kröger
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Meher Prakash
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Christine N. Manser
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- See-Spital Horgen, 8801, Horgen, Switzerland
| | - Henriette Heinrich
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Benjamin Misselwitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
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