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ABSTRACT: Eosinophilic enteritis is a rather rare condition that can manifest anywhere from esophagus to rectum. Its description in the literature is sparse, but associations have been made with collagen vascular disease, malignancy, food allergy, parasitic or viral infections, inflammatory bowel disease, and drug sensitivity. We present the case of a 41-year-old male diagnosed with ulcerative colitis who underwent proctocolectomy with ileal pouch anal anastomosis and loop ileostomy formation utilizing Seprafilm®, who later developed eosinophilic enteritis of the loop ileostomy site. This is the first report of eosinophilic enteritis and its possible link to the use of bioabsorbable adhesion barriers.
Case Reports in Gastroenterology 05/2011; 5(2):422-7.
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ABSTRACT: Afternoon colonoscopies have higher failure rates, due primarily to poor bowel cleansing. Hypothesizing that the time of administration influences the quality of bowel cleansing, we compared the quality of bowel cleansing for afternoon colonoscopies in patients completing the preparation on the same day vs. the day before colonoscopy.
Data on afternoon colonoscopies performed between July 2008 and April 2009 were obtained from our endoscopy database. Bowel-preparation options were 4L polyethylene glycol (PEG) or 2L PEG plus four bisacodyl tablets. Patients could take the preparation on the same day as the procedure or the day prior, or consume half the day prior and half the same day. Bowel-cleansing quality was reported as excellent, good, fair-adequate, inadequate, or poor. Multivariate logistic regression analysis evaluated the association between quality of bowel cleansing and time of preparation administration.
Bowel cleansing was reported as poor or inadequate in 7% of patients, adequate in 63%, and good or excellent in 30%. Afternoon colonoscopies using the same-day 4L PEG preparation were 3.14 times more likely to have fair-adequate cleansing and 7.03 times more likely to have good or excellent cleansing when compared with the other options.
Same-day 4L PEG preparation for afternoon colonoscopy confers better-quality cleansing than prior-day preparation.
The American Journal of Gastroenterology 11/2010; 105(11):2318-22. · 7.28 Impact Factor
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ABSTRACT: Tropical sprue (TS), although endemic in certain tropical regions of the world, is rarely seen in North America and Europe. However, in this era of globalization and worldwide travel, it is important for all clinicians to be aware of the possibility of TS in patients presenting with nonspecific, persistent gastrointestinal complaints like diarrhea and weight loss. The symptoms and histologic findings of TS can resemble and be confused with those of diseases seen more commonly in nontropical climates like celiac disease and small intestine bacterial overgrowth. Therefore, if the usual causes of persistent diarrhea are ruled out, keeping a high index of suspicion for TS in patients who have a travel history to one of the endemic regions is important.
Case Reports in Gastroenterology 01/2010; 4(2):168-172.
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ABSTRACT: Safe and effective colonoscopy is aided by the use of endoscopic techniques and maneuvers (ETM) during the examination including patient repositioning, stiffening of the endoscope and abdominal pressure.
To better understand the use and value of ETM during colonoscopy by using a device that allows real-time imaging of the colonoscope insertion shaft.
The use of ETM during colonoscopy and their success was recorded. Experienced colonoscopists and endoscopy assistants used a commercially available electromagnetic (EM) transmitter and a special adult variable stiffness instrument with 12 embedded sensors to examine 46 patients. In 5 of these a special EM probe passed through the instrument channel of a standard pediatric variable stiffness colonoscope was used instead of the EM colonoscope.
Thirty-nine men and 7 women with a mean age of 64 years (range 33-90) were studied. The cecum was intubated in 93.5% (43/46). The mean time to reach the cecum was 10.6 minutes (range 3-25). ETM were used a total of 174 times in 41 of the patients to assist with cecal intubation. When ETM were required to reach the cecum, and the cecum was intubated, an average of 3.82 ETM/patient was used. While ETM were used most often when the tip of the colonoscope was in the left side of the colon (rectum 5.0%, sigmoid colon 20.7%, descending colon 5.0%, and splenic flexure 11.6%), when the instrument was in the transverse colon (14.8%), hepatic flexure (20.7%) and ascending colon (19.8%) the use of ETM was also required. When the colonoscope tip was in the transverse colon, hepatic flexure and ascending colon, ETM success rates were less (61.1%, 52.0%, and 41.7% respectively) compared to the left colon success rates (rectum 83.3%, sigmoid colon 84.0%, descending colon 100%, and splenic flexure 85.7%).
The EM colonoscope allows imaging of the insertion shaft without fluoroscopy and is a useful device for evaluating the efficacy of ETM. ETM are important tools of the colonoscopist and are used most often in the left colon where they are most effective.
BMC Gastroenterology 05/2009; 9:24. · 2.42 Impact Factor
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ABSTRACT: Colonoscopy is considered the primary procedure for colorectal cancer screening and prevention. However patient acceptance of this procedure has been poor. A major deterrent for patients is the need for a large-volume (4-l) preprocedure colonic preparation (polyethylene glycol [PEG] solution) that can be associated with a bad taste.
To determine patient preference and acceptance of the NaP tablet preparation in patients who have previously used PEG solutions for their prior colonoscopy exams.
Patients who had used a standard 4-l PEG solution preparation for a colonoscopy within the past 12 months and who were scheduled for a repeat colonoscopy were invited to participate in this study. A preprocedural questionnaire was administered to the patients. The primary outcome measure was whether the patient indicated a preference for the NaP tablet preparation over the previous PEG solution.
Thirty-five of 53 participants (66%) who completed the study preferred the NaP tablet preparation over 4-l PEG. A majority of patients also indicated that they would use the NaP tablet preparation again and would like to have a choice of preparation for their next colonoscopy.
Among patients who previously used a 4-l PEG preparation for colon cleansing and participated in this study, 66% of patients preferred the NaP tablet preparation over the PEG preparation for their colonoscopy.
Digestive Diseases and Sciences 11/2008; 54(7):1555-9. · 2.12 Impact Factor
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ABSTRACT: Abstract
Background
Many factors impacting cecal intubation rates have been examined in detail; however, little information exists regarding the effect of the timing of the procedure. We sought to examine any difference in cecal intubation rates between morning and afternoon colonoscopies and identify factors contributing to a discrepancy.
Methods
Retrospective, single-center study comparing cecal intubation rates for colonoscopies performed in the morning (begun prior to 12 noon) and colonoscopies performed in the afternoon (begun after 12 noon) over an approximately 12 month period. Univariate and multivariate analyses were performed evaluating patient demographics, procedure indication(s), endoscopist, bowel preparation type and quality, and participation by a gastroenterology fellow.
Results
6087 colonoscopies were evaluated in this study. Colonoscopies (n = 3729) performed in the morning were compared to colonoscopies performed in the afternoon (n = 2358). The crude completion rate to the cecum was 95.0% in the morning group while the completion rate to the cecum was 93.6% of the afternoon exams (p = 0.02). The morning colonoscopies had better bowel preparation quality (p < 0.001). The multivariate analyses demonstrated that gender, age, and bowel preparation quality impacted completion rates. After correcting for these factors, there was no significant difference in completion rates in the morning versus afternoon.
Conclusion
Uncorrected cecal intubation rates were lower in the afternoon compared to the morning in outpatients undergoing colonoscopy. Bowel preparation quality was worse in the afternoon compared with the morning. Efforts at improving afternoon bowel preparation may improve the outcome of afternoon colonoscopies.
BMC Gastroenterology. 01/2007;
