Gastrointestinal endoscopy最新文献

This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.

Background and aims: Intestinal strictures are a common and serious complication of inflammatory bowel disease (IBD). Endoscopic balloon dilatation (EBD) is the first step treatment to avoid the surgery. The aim of this study was to assess the prevalence, risk factors and clinical sequelae of difficult EBD. In this retrospective, multi-center study, 861 IBD patients treated with EBD due to strictures were included. We evaluated the risk factors for difficult EBD, defined as a ≥3 per year.

Results: During 23.00 (14.00;42.00) months of median follow-up there were 392 (45.5%) easier EBD performed, while difficult EBD were done in 489 (54.5%) cases. Long term efficacy of EBD, defined as a >12 months without surgery was achieved in 392 (100%) easier vs in 457 (97.4%) difficult EBD, V = 0.11, P = 0.004. However, 149 (17.3%) patients underwent surgery due to unsuccessful EBD. The most important risk factors for difficult EBD, classified as modifiable, were smoking and treatment with adalimumab (especially if through level was normal) and ustekinumab. While vedolizumab (VDZ) and immunosuppressive therapy was identified as a protective factor. The multivariable logistic regression indicated good fit of the model to the data, pointing to protective role of total parental nutrition (TPN) and worsening of smoking (for both P < 0.001).

Conclusions: Reduction of difficult EBD should be considered primarily in the context of their modifiable risk factors. Prospective studies with simultaneous evaluation of transmural healing are needed to truly assess whether VDZ treatment, immunosuppressive therapy and total parenteral nutrition reduce the risk of EBD.