Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials.

Background: Polyethylene glycol (PEG) is a commonly used bowel preparation for colonoscopy. Unfortunately, the standard large-volume solution may reduce patient compliance. Split-dosing of PEG has been studied in various randomized, controlled trials (RCTs).

Prophylactic antibiotics in necrotizing pancreatitis: a meta-analysis.

Purpose: Prophylactic antibiotics have been used in acute necrotizing pancreatitis with mixed results. This meta-analysis analyzes the effects of prophylactic antibiotics in necrotizing pancreatitis.

Methods: Multiple databases and abstracts were searched for randomized trials comparing treatment with prophylactic antibiotics to treatment without prophylactic antibiotics in necrotizing pancreatitis.

Effect of music on patients undergoing colonoscopy: a meta-analysis of randomized controlled trials.

Purpose: Music has been utilized as a therapeutic tool during colonoscopy, but various randomized controlled trials (RCTs) have been inconsistent. We conducted a meta-analysis to analyze the effect of music on patients undergoing colonoscopy.

Patients And Methods: Multiple medical databases were searched (12/06).

En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video).

Background: Endoscopic submucosal dissection (ESD) was recently developed in Japan for en bloc removal of laterally spreading tumors (LSTs). Although initially used for gastric tumors, ESD has now been applied to lesions elsewhere in the gut. Recent reports from Japan included removal of colorectal lesions up to 10 cm.

How adequate is digital rectal exam for prostate cancer screening at colonoscopy? Can adequacy be improved?

Purpose: Screening by digital rectal exam (DRE) has been advocated as a means of detecting early-stage prostate cancer. We sought to determine the adequacy of prostate palpation at DRE at colonoscopy, and to devise a method of improving adequacy when the gland is incompletely felt.

Materials And Methods: Adequacy of prostate palpation in the left lateral position was prospectively assessed in 200 males 40 years or older undergoing colonoscopy, and correlated with body mass index (BMI) and National Institutes of Health (NIH) weight categories.

Bravo (wireless) ambulatory esophageal pH monitoring: how do day 1 and day 2 results compare?

Aim: To investigate if differences exist for patients' gastroesophageal reflux as measured by the Bravo ambulatory esophageal pH system between d 1 and d 2.

Methods: A retrospective study of 27 consecutive adult patients who underwent Bravo esophageal pH monitoring was performed. Patients underwent EGD under IV conscious sedation prior to Bravo placement.

Effect of music on patients undergoing outpatient colonoscopy.

Aim: To evaluate the effect of relaxing music during colonoscopy under low-dose conscious sedation, on patient satisfaction, scope insertion time and procedure duration, medication doses, and the perceived adequacy of sedation and scope insertion difficulty on the part of the endoscopist.

Methods: One hundred and sixty-seven consecutive adult outpatients presenting for routine colonoscopy under low-dose conscious sedation were randomized to undergo their procedures either with music played during the procedure or no music played.

Results: There were no statistical differences between the two groups in terms of meperidine dose, midazolam dose, time to reach the cecum, total procedure time, endoscopist assessment of scope insertion difficulty, endoscopist assessment of adequacy of sedation, or the pain experience of the patients during their procedure.

Usefulness of a pediatric colonoscope for routine colonoscopy in women who have undergone hysterectomy.

Background: Colonoscopy can be difficult in some women who have undergone hysterectomy, which can be associated with a fixed, angulated sigmoid colon caused by postoperative pelvic adhesions. Our goal was to determine whether colonoscopy is easier and more comfortable for women after hysterectomy when performed with a pediatric colonoscope, which is thinner in diameter and more flexible than a standard "adult" colonoscope.

Methods: One hundred women with a history of hysterectomy undergoing outpatient colonoscopy were randomized in unblinded fashion to colonoscopy with a standard colonoscope (CF-100L or CF-Q140L, Olympus) or with a pediatric colonoscope (PCF-100, Olympus).

Severe gastroesophageal reflux disease.

Preview Medical and surgical choices for treating gastroesophageal reflux disease have never been better. In the last few years, potent medications have been introduced that suppress gastric acid production and have promotility effects, and laparoscopic approaches to antireflux surgery have been developed. In this article, Dr Marshall reviews current management techniques and explains how to decide which to recommend in a given patient with severe disease.

Acute polyarthritis.

Preview Although erythema infectiosum occurs primarily in children, the infection may be responsible for acute arthritis or arthralgia in adults. In this article, a case of acute symmetric polyarthritis affecting one of the authors is described. His symptoms were caused by parvovirus B19 infection, which was probably acquired from one of his children who had had erythema infectiosum a short time earlier.

Current options in gallstone management.

Preview Should surgery to remove gallstones be deferred until symptoms occur? When should therapy with oral bile acids, lithotripsy, or methyl tert-butyl ether be considered? How should nonspecific dyspeptic symptoms in a patient with cholelithiasis be managed? Dr Marshall discusses these and other questions and controversies.