The presence of small air bubbles and foam are an impediment to a successful colonoscopy. They impair an endoscopist's view and diminish the diagnostic accuracy of the study. This has been particularly noted to be of concern with the switch to lower volume polyethylene glycol (PEG) and bisacodyl combination preparation.To evaluate the effect of oral simethicone addition to bowel preparation on intraluminal bubbles reduction during colonoscopy.Described is a prospective, randomized, multi-center, double-blinded, placebo-controlled study to evaluate the use of premixed simethicone formulation with split-regimen, low-volume PEG-bisacodyl combination bowel preparation for 168 outpatients undergoing screening, surveillance, and diagnostic colonoscopies. Primary outcome includes evaluation of bubbles during colonoscopy graded using the Intraluminal Bubbles Scale. Secondary outcomes include evaluation of the Boston Bowel Preparation Scale (BBPS), total number of polyps, polyp size differentiation, polyp laterality, adenoma detection, mass detection, cecal insertion time, withdrawal time, and patient-reported adverse events.Higher Intraluminal Bubbles grades III and IV (less than 75% of the mucosa cleared of bubbles/foam requiring intervention with simethicone infused wash) were detected in the placebo group [Simethicone n = 4/84 vs Placebo n = 20/84 (P = 0.007)]. BBPS total score was 7.42 [standard deviation (SD) = ± 1.51] in the simethicone group and 7.28 (SD = ± 1.44) in the placebo group (P = 0.542) from a total of 9. Significantly higher number of adenomas were detected in the simethicone group (P = 0.001).The addition of simethicone to bowel preparation is well advised for its anti-foaming properties. The results of this study suggest that addition of oral simethicone can improve bowel wall visibility.
This systematic review aims to evaluate the risk factors, clinical features, and outcomes of bowel perforation caused by stent migration after endoscopic retrograde cholangiopancreatography (ERCP).
Abdallah, Mohamed A. MD1; Ahmed, Khalid M. MD1; Gohar, Ahmed MD1; Abdalla, Abubaker O. MD2; Waqas, Qazi MD1; Elgouhari, Hesham MD, FACP3; Huntington, Mark K. MD, PhD, FAAFP4 Author Information
Introduction: Endoscopic Submucosal Dissection (ESD) has emerged as an effective therapeutic approach for managing early esophageal neoplasia. Despite its demonstrated efficacy, post-operative stricture remains a significant concern, particularly in cases involving wide field resection. This meta-analysis aimed to assess the rates of stricture formation following esophageal ESD. Methods: A comprehensive search of databases, including PubMed and EMBASE, from inception through March 2023 was performed for studies assessing the post-esophageal ESD stricture rates irrespective of the preventive strategy used. The rates were pooled with their corresponding confidence intervals (CI) utilizing a proportion meta-analysis and via the random effects model. The primary outcome was the ESD-associated stricture rate. Additionally, we performed a subgroup analysis assessing stricture rate in cases involving >75% of esophageal circumference. The heterogeneity across studies was examined using the I-squared (I2) statistic. Results: Twenty-four studies were included in this analysis, including 2752 patients or lesions. The post-ESD stricture rate was 17.3% (CI: 13.% - 22.6%; I2: 86%). A significantly higher stricture rate was noted in the subgroup analysis of 3 studies with ESD involving >75% of esophageal circumference, with an estimated rate of 81.5% (CI: 4.9% - 99.7%; I2: 94.8%). Two of these studies involved ESD of >75% of esophageal circumference, and 1 study involved 100% circumferential resection (Figure 1). Conclusion: This meta-analysis highlights the significant stricture rate following ESD, with a markedly elevated risk in cases involving wide field resection of >75% of esophageal circumference. The findings highlight the importance of prevention strategies, careful patient selection, and specialized postoperative management. Various preventive strategies exist, however, the risk remains relatively high. Thus, further research is needed to explore more efficacious interventions to reduce stricture rates after esophageal ESD.Figure 1.: A) Forest plot summarizing stricture rates following esophageal endoscopic submucosal dissection (ESD); B) Forest plot summarizing stricture rates following esophageal endoscopic submucosal dissection (ESD) of >75% of esophageal circumference.
BACKGROUND:Calciphylaxis is a rare cutaneous disease, also known as calcific uremic arteriolopathy, that occurs most frequently in patients with advanced chronic kidney disease and on long-term hemodialysis. CASE REPORT:We describe the case of a 61-year-old female patient with worsening chronic kidney disease not on dialysis therapy, who presented with severe progressive calciphylaxis on both lower limbs. CONCLUSIONS:Calcific uremic arteriolopathy is a rare fatal condition that requires prompt diagnosis and treatment. It is classically described in patients with end-stage kidney disease on long-term renal replacement therapy but can present in patients with an earlier stage of kidney disease. Non-uremic calciphylaxis should be suspected in patients with earlier stages of kidney disease, especially in those with other concurrent risk factors or co-morbid conditions, to avoid the high risk of morbidity and mortality associated with such cases.
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