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BACKGROUND: One-day low-residue diet (LRD) is recommended before colonoscopy, but only three single-center trials compared the 1-day versus 3-day LRD. The aim of this multicenter study was to compare the impact of a 3-day versus 1-day LRD on its ability to adequately and successfully prepare the bowel of outpatients that require a colonoscopy. The outpatients' tolerance and adherence to the LRD were also considered. METHODS: Consecutive outpatients were randomized to 1-day versus 3-day LRD at three open-access endoscopy units. The primary endpoint consisted of the proportion of patients with a satisfactory degree of bowel cleanliness (Score 2-3 on the Boston Bowel Preparation Scale [BBPS] in each segment). Secondary endpoints were patients' tolerance and adherence to the prescribed diet evaluated by a standardized questionnaire. RESULTS: 289 patients were included in the study (1-day LRD arm = 143, 3-day LRD arm = 146). BBPS ≥2 was not significantly different in the two dietary regimens in any of the three colonic segments (71% vs. 72%, p = 0.9). The percentage of patients with incomplete preparation was similar in the two arms (9% vs. 9%; p = 1.0). No significant differences were found among colonoscopy findings in terms of abnormalities (81% vs. 84%, p = 0.8). Both groups scored similarly in overall tolerance to LRD (48% vs. 49%, p = 1.0) and also in whether they would have adopted a different dietary regimen (p = 0.3). CONCLUSION: Our multicenter randomized study confirmed that optimal bowel cleansing is reached through a 1-day LRD.
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Catárticos , Colonoscopía , Humanos , Colon , Dieta , Cuidados Preoperatorios , PolietilenglicolesRESUMEN
BACKGROUND Endoscopic full-thickness resection represents an innovative procedure, used in selected patients that allows lesions en-bloc resection with an integral wall specimen available for histopathological definition. Bleeding and perforation are known to be the most frequent procedure-related adverse events. We report a case of entero-colonic fistula as complication of an endoscopic full-thickness resection. CASE REPORT A 77-year-old male, with a personal history of right-hemicolectomy for a colonic adenocarcinoma presented to our department for a routine colonoscopy that showed the presence of a 25 mm lateral spreading tumor localized at about 50 cm from the anal margin. A full-thickness resection of the lateral spreading tumor using the over-the-scope clip device was performed. After 4 weeks, because of abdominal pain, weight loss, diarrhea, and signs of malnutrition, the patient underwent a new colonoscopy showing hyperemic mucosa with ulcerations in all colonic segments and, at the site of the previous endoscopic full-thickness resection, an orifice of an entero-colonic fistula. The histological definition was suggestive for ulcerative proctocolitis and confirmed the presence of small bowel mucosa at fistula orifice. An intussusception at the level of fistula with consequent intestinal obstruction caused a worsening of clinical conditions and finally the patient death for a septic peritonitis. CONCLUSIONS Full thickness resection represents an innovative tool for en-bloc resection of gastrointestinal tumoral lesion, but procedural complications and limitations must be considered before performing this procedure.
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Colon/cirugía , Neoplasias del Colon/cirugía , Resección Endoscópica de la Mucosa , Anciano , Colonoscopía , Fístula del Sistema Digestivo/etiología , Resección Endoscópica de la Mucosa/efectos adversos , Resultado Fatal , Humanos , Fístula Intestinal/etiología , Obstrucción Intestinal/etiología , Masculino , Peritonitis/etiología , Proctocolitis/etiología , Sepsis/etiologíaRESUMEN
INTRODUCTION: Stone extraction represents the most frequent indication for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic papillary large balloon dilation (EPLBD) is a recent introduced approach consisting of an endoscopic papillary large balloon dilation following limited endoscopic sphyncterotomy (ES), which has been proven to be safe and effective for extraction of large common bile duct (CBD) stones. Peri-ampullary diverticula (PAD) are described in 10-20% of patients undergoing ERCP. Aim of our study is to evaluate efficacy and safety of EPLBD for the extraction of large biliary stones in patients with PAD. METHODS: The prospectively collected endoscopy databases of 4 Italian ERCP high-volume centers were reviewed retrospectively, and all consecutive patients with an instrumental diagnosis of large biliary stones and PAD, between September 2014 and October 2016, were included in this study. RESULTS: Eighty-one patients (36 males, median age 75â¯years) were treated between September 2014 and October 2016. Deep biliary cannulation was reached in 78/80 patients. Successful extraction was achieved in 74/78 patients at the first attempt. AEs occurred in 8 patients (1 severe). Younger age, stone size and incomplete stone extraction were significantly associated with AEs. CONCLUSIONS: EPLBD is an effective and safe technique in patients with PAD and large biliary stones, which avoids the need of other techniques, thereby reducing the risks of adverse events.
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Ampolla Hepatopancreática , Divertículo/cirugía , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/cirugía , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica , Dilatación/métodos , Divertículo/etiología , Femenino , Humanos , Italia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esfinterotomía Endoscópica , Resultado del TratamientoRESUMEN
BACKGROUND: Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBD) of unknown aetiology. The 'hygiene hypothesis' (HH) suggests that several hygiene-related factors may have contributed to the increased incidence of IBD. The aim of the study was to evaluate risk factors for IBD related to HH in a cohort of IBD patients from the south of Italy. METHODS: We prospectively performed a one-year, questionnaire-based, case-control, multi-centre study focusing on the principal risk factors for IBD according to HH. We investigated the main surrogate markers of HH (helmintic infections and antibiotics in childhood; breastfeeding; family size/sibship;urban upbringing; personal and domestic hygiene in childhood) in UC and CD patients, in comparison with a control group of healthy subjects. In addition, the traditional risk factors for IBD were also recorded. RESULTS: The study population included 527 cases of UC, 468 CD and 562 controls. None of the surrogate risk factors of HH was significantly associated with IBD. On the contrary, the traditional risk factors confirmed their statistical significance in this IBD population. Familial aggregation: OR 4.07 for UC; OR 4.83 for CD; smoking: OR 0.38 for UC; OR 1.40 for CD; appendectomy: OR 0.28 for UC; OR 1.61 for CD. CONCLUSION: Even though risk factors associated to the HH have been proposed as a possible explanation for the increasing calendar trend of IBD incidence, their role does not appear to be statistically significant. Familial aggregation, smoking habits and appendectomy still remain the main risk factors associated with IBD.
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Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Hipótesis de la Higiene , Adolescente , Adulto , Antibacterianos/uso terapéutico , Apendicectomía/efectos adversos , Lactancia Materna , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Niño , Colitis Ulcerosa/genética , Enfermedad de Crohn/genética , Composición Familiar , Femenino , Helmintiasis/epidemiología , Humanos , Higiene , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Fumar/efectos adversos , Encuestas y Cuestionarios , Población Urbana , Adulto JovenRESUMEN
BACKGROUND/AIMS: The outcome of endoscopic biliary stent insertion for postoperative bile duct stenosis was retrospectively evaluated. METHODOLOGY: Fifty-seven patients with biliary stenosis from laparoscopic cholecystectomy were included from February 1992 to January 2000. One to three stents were inserted for an average of 12.4 months, with stent exchange every 3 months to avoid cholangitis caused by clogging. RESULTS: Successful stent insertion was achieved in 43/57 (75.4%) patients. Stent insertion failed in 10 patients with complete and in 4 patients with incomplete biliary obstruction. Early complications occurred in 4 patients. Late complications occurred in 5/43 patients. Five patients experienced recurrence of stenosis. CONCLUSIONS: Endoscopic treatment should be the initial management of choice for postoperative bile duct stenosis.