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Age Is the Only Predictor of Poor Bowel Preparation in the Hospitalized Patient
We examine the impact of key variables on the likelihood of inpatient poor bowel preparation for colonoscopy. Records of inpatients that underwent colonoscopy at our institution between January 2010 and December 2011 were retrospectively extracted. Univariable and multivariable logistic regression models were fitted to assess the effect of clinical variables on the odds of poor preparation. Tested predictors included age; gender; use of narcotics; heavy medication burden; comorbidities; history of previous abdominal surgery; neurological disorder; product used for bowel preparation, whether or not the bowel regimen was given as split or standard dose; and time of endoscopy. Overall, 244 patients were assessed including 83 (34.0%, 95% CI: 28.1–39.9%) with poor bowel preparation. Cecal intubation was achieved in 81.1% of patients (95% CI: 76.2–86.0%). When stratified by quality of bowel preparation, cecal intubation was achieved in only 65.9% (95% CI: 60.0–71.9%) of patients with poor bowel preparation and 89.9% (95% CI: 86.1–93.7%) of patient with good bowel preparation. In multivariate logistic regression analysis, only advancing age was an independent predictor of poor bowel preparation (OR = 1.026, CI: 1.006 to 1.045, and p = 0.008). Age is the only independent predictor of poor bowel preparation amongst hospitalized patients
Safety of Digestive Endoscopy following Acute Coronary Syndrome: A Systematic Review
Background. The safety of endoscopy after an acute coronary syndrome (ACS) is poorly characterized. We thus performed a systematic review assessing the safety of endoscopy following ACS. Methods. Searches in EMBASE, Medline, and Web of Science identified articles for inclusion. Data abstraction was completed by two independent reviewers. Results. Fourteen retrospective studies yielded 1178 patients (mean 71.3 years, 59.0% male) having suffered an ACS before endoscopy. Patients underwent 1188 endoscopies primarily to investigate suspected gastrointestinal bleeding (81.2%). Overall, 810 EGDs (68.2%), 191 colonoscopies (16.1%), 100 sigmoidoscopies (8.4%), 64 PEGs (5.4%), and 22 ERCPs (1.9%) were performed 9.0±5.2 days after ACS, showing principally ulcer disease (25.1%; 95% CI 22.2–28.3%) and normal findings (22.9%; 95% CI 20.1–26.0%). Overall, 108 peri- and postprocedural complications occurred (9.1%; 95% CI 7.6–10.9%), with hypotension (24.1%; 95% CI 17.0–32.9%), arrhythmias (8.1%; 95% CI 4.5–18.1%), and repeat ACS (6.5%; 95% CI 3.1–12.8%) as the most frequent. All-cause mortality was 8.1% (95% CI 6.3–10.4%), with 4 deaths attributed to endoscopy (<24 hours after ACS, 3.7% of all complications; 95% CI 1.5–9.1%). Conclusion. A significant proportion of possibly endoscopy-related negative outcomes occur following ACS. Further studies are required to better characterize indications, patient selection, and appropriate timing of endoscopy in this cohort