Colonoscopias realizadas por médicos residentes em hospital universitário: análise consecutiva de 1000 casos

Abstract

<jats:p>RACIONAL: A colonoscopia tem indicação para diagnóstico em pacientes sintomáticos e é eficaz no rastreamento e vigiância de pacientes assintomáticos. Tem potencial terapêutico em diversas situções, principalmente na remoção das lesões polipóides. A proficiência e a competência do endoscopista é o esteio para o sucesso da colonoscopia diagnóstica e terapêutica. OBJETIVO: Analisar as indicações, os achados diagnósticos, e as complicações de colonoscopias realizadas por médicos residentes em um hospital universitário. MÉTODOS: Foram avaliadas 1.000 colonoscopias consecutivas realizadas por residentes de quarto ano, sob supervisão direta de colonoscopistas experientes. Foram obtidas informações sobre os dados demográficos dos pacientes, o preparo intestinal, as indicações para o procedimento, o sucesso do procedimento, os achados diagnósticos e as complicações. RESULTADOS: Foram examinados total de 596 (59,6%) mulheres e 404 (40,4%) homens. A idade variou de três a 99 anos (média 53,8). O preparo intestinal foi realizado com solução de manitol a 10% em 978 pacientes (97,8%), sendo considerada adequada em 97,6% dos casos. Principais indicações foram: diagnóstico (56,4%), terapêutica (9,6%), rastreamento (17,3%) e vigilância (22%). Taxas de intubação do ceco e válvula ileocecal foram 90,3 e 58,6%, respectivamente. A colonoscopia foi normal em 45,8% dos casos. O diagnóstico mais comum foi diverticulose (18,5%), seguido por pólipos (17%) e neoplasias (6,8%). Achados consistentes com um processo inflamatório foram identificados em 122 pacientes (12,2%) e anomalias vasculares foram detectadas em 11 pacientes (1,1%). Outros diagnósticos representaram 3,9% dos casos. Houve dois casos (0,2%) de complicações (hematoma e hemorragia submucosa), ambos após polipectomia, sem necessidade de intervenção cirúrgica. CONCLUSÃO: Os residentes sob supervisão e orientação de especialistas podem realizar colonoscopias com excelente resultado, baixo índice de complicações e com dados finais comparáveis aos obtidos por endoscopistas experientes.</jats:p>

Factors influencing the presence of potentially explosive gases during colonoscopy: Results of the SATISFACTION study

“…In Latin America, particularly Brazil, mannitol continues to be the most widely used preparation for bowel cleansing due to its efficacy, ease of use and high acceptance rates by patients, with no case of explosion reported. 16,17 The results of phase III also allow evaluation, for the first time ever, of the role of other factors possibly affecting residual concentrations of H 2 and CH 4 , such as the insufflation and washing maneuvers performed during colonoscopy. The O 2 levels indicate the efficacy of insufflation: an O 2 concentration similar to that in ambient air (>20% vol) denotes gaseous equilibrium between the lumen of the colon and the outside air, that is, complete gas exchange.…”

“…These results for mannitol used for bowel cleansing are consistent with real‐world data. In Latin America, particularly Brazil, mannitol continues to be the most widely used preparation for bowel cleansing due to its efficacy, ease of use and high acceptance rates by patients, with no case of explosion reported 16,17 …”

Pharmacokinetics of oral mannitol for bowel preparation for colonoscopy

“…Mannitol is a sugar alcohol with an osmotic effect due to fluid retention in the intestinal lumen and is commonly used in Latin America (mainly in Brazil) as an off-label formulation for bowel cleansing before colonoscopy. 17,23,24 Oral mannitol for bowel preparation is cheap and has a pleasant taste, low volume (<1 L), and very early onset of action, which allows same-day bowel preparation even for a morning colonoscopy. 12 As a result, mannitol is an easyto-use bowel preparation with high patient acceptability.…”

“…However, other extremely rare cases of intestinal explosion were also reported in patients prepared for colonoscopy using a standard enema, 15 PEG, and sorbitol, 16 suggesting that the causes of the explosion may be other than the drug used for bowel cleansing. Remarkably, these events have no longer been described in recent years, even in those countries where the use of mannitol is widespread, 17 probably because the routinary maneuvers of insufflation and washing to optimize bowel cleansing contribute to an effective gas exchange with the ambient air and equalize the distribution of combustible gases, overcoming the compartmentalization of the colon 18,19 . The above considerations lead us to believe that mannitol may represent an optimal choice for bowel cleansing as, with equal efficacy with PEG‐based preparations, it may be better accepted by patients because of its ease of use, small solution volume to be taken, pleasant taste, and rapidity of action, without a real increase of the intestinal explosion risk.…”

“…15 However, other extremely rare cases of intestinal explosion were also reported in patients prepared for colonoscopy using a standard enema, 15 PEG, and sorbitol, 16 suggesting that the causes of the explosion may be other than the drug used for bowel cleansing. Remarkably, these events have no longer been described in recent years, even in those countries where the use of mannitol is widespread, 17 probably because the routinary maneuvers 7.403 ± 3.472 mg/ml*h in the 50, 100, and 150 g mannitol dose groups, respectively. Bioavailability was similar in the three dose groups and was just over 20% (0.243 ± 0.073, 0.209 ± 0.081, and 0.228 ± 0.093 in the 50, 100, and 150 g mannitol dose groups, respectively).…”