IntroductionAdequate bowel preparation is a prerequisite for effective colonoscopy. Split bowel preparation results in optimal cleansing. This study assessed the bowel preparation regimes advised by endoscopy units across the UK, and correlated the differences with outcomes.MethodsTrusts in the UK were surveyed, with data requested between January 2018 and January 2019, including: the type and timing of preparation, pre-endoscopy diet, adequacy rates and polyp detection. Trusts were grouped according to the timing of bowel preparation. χ2 test was used to assess for differences in bowel preparation adequacy.ResultsMoviprep was the first line bowel preparation in 79% of trusts. Only 7% of trusts advised splitting bowel preparation for all procedures, however, 91% used split bowel preparation for afternoon procedures. Trusts that split preparation for all procedures had an inadequacy rate of 6.7%, compared with 8.5% (p<0.001) for those that split preparation for PM procedures alone and 9.5% (p<0.001) for those that provided day before preparation for all procedures. Morning procedures with day-before preparation had a higher rate of inadequate cleansing than afternoon procedures that received split preparation (7.7% vs 6.5 %, p<0.001). The polyp detection rate for procedures with adequate preparation was 37.1%, compared with 26.4% for those that were inadequate.ConclusionMost trusts in the UK do not provide instructions optimising the timing of bowel preparation prior to colonoscopy. This correlated with an increased rate of inadequate cleansing. Splitting bowel preparation is likely to reduce the impacts of poor cleansing: missed lesions, repeat colonoscopies and significant costs.
A 32-year-old man presented with profound jaundice, rigors and decreased appetite. Initial liver function tests (LFTs) were deranged in a cholestatic pattern with imaging demonstrating a dilated biliary system, with no filling defects. It has been observed that LFTs typically improve upon ketamine cessation, but this case demonstrated escalating hyperbilirubinaemia, despite ketamine cessation. Recurrent cholangitis and biliary duct stricturing were demonstrated on magnetic resonance cholangiopancreatography (MRCP). This prompted investigation of other biliary pathology and consideration for intervention.
adjusted and left in stomach for a period of 12 months. Its use in super obese patients has not been studied.Aim to retrospectively evaluate the effectiveness of SAB3 in super-obese patients (BMI!50 kg/m²) as bridge to definitive surgery and report the complications associated with it. Methods Super obese patients who had SAB inserted and completed !6 months of follow up were included in the study. The absolute weight loss, mean percent excess weight loss (%EWL) and the% total body weight loss (%TBWL) at 3, 6 and 12 months was recorded from hospital electronic system. Results A total of 60 patients with a mean (±SD) age, initial BMI and weight of 41 years (± 12), 68.59 kg/m² (± 9.57) and 183.45 kgs (± 32.81), respectively had SAB inserted. Data was available on 51, 60 and 31 patients at 3, 6 and 12 months. The mean%EWL at these time points was 10.04 (± 8.36), 10.45 (± 9.85) and 27.92 (27.88).% Patients with >10%TBWL at same time points was 21.6%, 35% and 58%, respectively (table 1 below). 21 (40.4%) patients went on to have a definitive bariatric surgery to date. Complications associated with SAB were abdominal pain in 16.7% (10), severe enough in 6 for unplanned SAB removal, gastroesophageal reflux 13.3% (8), intestinal obstruction 1.7% (1), migration 1.7% (1), deflation in 6.7% (4), nausea/vomiting 12% (7). Conclusion SAB placement in our center was safe, tolerable and achieved the desired weight loss in majority of the superobese patients. The rate of SAB early removal was in keeping with real world literature.
A 26-year-old woman presented with a 3-month history of worsening episodic abdominal pain, which was associated with frequent passage of watery stools, nausea and dyspepsia. Her peripheral eosinophil count was markedly elevated. This responded well to a reducing regimen of corticosteroids. Her symptoms completely resolved with a corresponding fall in eosinophil count. The patient was diagnosed with eosinophilic gastroenteritis. We have not considered steroid-sparing agents at this point, but should she have future exacerbations then this will be considered.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.