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.
A large-volume bowel preparation regimen finished on the day of colonoscopy as close as 3 hours before the procedure results in no increase in GRV or decrease in gastric pH.
We report a case of a 63-year-old man with a history of monoarthritis, thought to have Rheumatoid Arthritis (RA) and treated with disease-modifying antirheumatic drugs (DMARDs). No clinical or serological improvement was observed. After five months synovectomy was performed. A foreign body was recovered, and synovial fluid analysis revealed a rare fungal infection, Phaeoacremonium sp. This is an educational case that reveals potential pitfalls of the specificity of using the current classification criteria for Rheumatoid Arthritis (RA) as a diagnostic tool in patients presenting with monoarthritis and highlights the need to continually reassess the diagnosis when there's inadequate response to treatment.
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