Goals:
We compare bowel cleanliness in patients taking same-day versus split-dose 4-L polyethylene glycol laxative for afternoon colonoscopy. Secondary objectives included patient satisfaction, adverse effects and patient tolerability.
Background:
Afternoon colonoscopies have been associated with inadequate bowel preparation and lower adenoma detection rates. Same-day (morning) or split-dosing of the laxative have improved preparation quality but differences between these options are unclear.
Materials and methods:
Single-center prospective randomized endoscopist blinded trial. Patients aged 18 years and above prescribed 4-L polyethylene glycol for colonoscopy were randomized into same-day or split-dose preparation. Preparation quality was assessed using the Ottawa Bowel Preparation Scale. Patient satisfaction and side effects was collected using a questionnaire. Intention-to-treat and per-protocol analysis were performed.
Results:
A total of 300 patients (158 split-dose, 142 same-day) were evaluated. No statistically significant difference was seen on total Ottawa score among the groups (P=0.47) or by individual colonic segments in intent-to-treat and per-protocol analysis. Patients in split-dose group were more likely to complete the entire preparation (P=0.01) but reported more sleep loss (P=0.001). The same-day preparation group reported higher incidence of vomiting (P=0.036). Patients ingesting bowel preparation ≥7 hours before colonoscopy had higher total Ottawa scores (P=0.001).
Conclusions:
There were no differences in quality of preparation in patients taking same-day versus split-dose preparation for afternoon colonoscopy. Those receiving same-day preparation were less likely to lose sleep but more likely to have emesis. These differences should be considered when selecting a bowel preparation regimen.
To determine the utility of the measurement of serum amylase (SA), drain fluid amylase (DFA) and serum CRP on post-operative day (POD) 1, 3, 5 and 7 as a predictor for development of pancreatic fistula (PF) after pancreatic resection. Methods: A prospective clinical study enrolled Seventyfour patients who underwent pancreatic resection, out of which 65 had Pancreaticoduodenectomy. All patients had estimation of DFA, SA and 55 patients had estimation of CRP levels on POD 1, 3, 5 and 7. Post-operative PF was classified according to International Study Group of Pancreatic Surgery into three grades (A, B, C). Results: Twenty two (29.72%) patients developed PF, 13(17.6%) had PF grade A(PF-A), 8(10.8%) had PF grade B(PF-B), 1(1.4%) patient had PF grade C(PF-C). Out of them clinically relevant fistula (CR-POPF) were 9(12.2%). DFA levels on POD 1 were not different in patients after Pancreaticoduodenectomy or all pancreatic surgery for CR-POPF vs. no PF/PF-A (p = 0.649, 0.679). CRP was significantly elevated in both Pancreaticoduodenectomy and all pancreatic surgery group on POD 3 in CR-POPF vs. no PF/ PF-A (234 vs 146 mg/l, p = 0.016). SA on POD 1 was also significantly higher in patients who developed PF in both Pancreaticoduodenectomy and all pancreatic surgery group for CR-POPF vs no PF/PF-A (p = 0.008, 0.006). Conclusion: Measurement of drain fluid amylase on POD 1 is not helpful in prediction of PF. CRP level on POD 3 and serum amylase on POD 1 however can predict he development of POPF.
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