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Canadian Association of Radiologists... Aug 2021
Topics: Abdomen; Administration, Oral; Contrast Media; Diatrizoate Meglumine; Emergency Service, Hospital; Humans; Intestinal Obstruction; Intestine, Small; Pelvis; Time Factors; Tomography, X-Ray Computed; Workflow
PubMed: 32936681
DOI: 10.1177/0846537120957322 -
European Radiology Aug 2020Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications...
Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay.
OBJECTIVES
Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications remains challenging. Our aim was to report the radiological findings on meglumine diatrizoate esophagograms after esophageal POEM and identify variables associated with patient outcomes.
METHODS
The imaging and clinical files of 106 patients who underwent POEM for achalasia or other major obstructive esophageal motility disorders were retrospectively analyzed. Post POEM esophagograms were reviewed for the presence of pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips. Associations between length of hospital stay and radiological findings were searched for using a Cox multivariate analysis.
RESULTS
A total of 106 patients (M/F = 56/50; mean age = 50 ± 2 [SD] years) underwent 106 POEM procedures with a meglumine diatrizoate esophagogram on postoperative day 1. Overall median hospital stay was 3 days (range 1-20 days). Pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips were observed in 90/106 (84.9%), 12/106 (11.3%), 4/106 (3.8%), and 0/106 (0%) patients, respectively. At multivariate analysis, pleural effusion (p = 0.005; adjusted hazard ratio [aHR] = 0.35 [95% CI 0.17-0.73]) and extraesophageal contrast leakage (p = 0.039; aHR = 0.27 [95% CI 0.08-0.94]) were associated with a prolonged hospital stay. Pneumoperitoneum was not associated with unfavorable outcome (p = 0.99).
CONCLUSIONS
Pneumoperitoneum is a common finding after POEM and is not indicative of unfavorable patient outcome. Conversely, post POEM pleural effusion and extraesophageal contrast leakage are associated with a longer hospital stay.
KEY POINTS
• Water-soluble esophagogram is a valid diagnostic modality to diagnose early complications after esophageal endoscopic myotomy for esophageal motility disorders. • At multivariate analysis, pleural effusion and extraesophageal contrast leakage are associated with a prolonged hospital stay after peroral endoscopic myotomy. • Pneumoperitoneum is not associated with unfavorable outcome after peroral endoscopic myotomy.
Topics: Adult; Aged; Contrast Media; Diatrizoate Meglumine; Esophageal Achalasia; Esophageal Motility Disorders; Esophagus; Female; Humans; Length of Stay; Male; Middle Aged; Myotomy; Natural Orifice Endoscopic Surgery; Pneumoperitoneum; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 32170414
DOI: 10.1007/s00330-020-06758-0 -
Radiography (London, England : 1995) Nov 2020To investigate the impact of two Meglumine-Diatrizoate based bowel preparation regimes for computed tomography colonography (CTC) on the patient experience and image...
INTRODUCTION
To investigate the impact of two Meglumine-Diatrizoate based bowel preparation regimes for computed tomography colonography (CTC) on the patient experience and image quality.
METHODS
100 patients consumed Meglumine-Diatrizoate at 24 h and 12 h prior to the CTC examination. 50 patients followed regime 1 (50:50), 50 ml of Meglumine-Diatrizoate at both 24 and 12 h prior to the examination. 50 patients followed regime 2 (75:25), 75 ml of Meglumine-Diatrizoate at 24 h prior to the examination and 25 ml of Meglumine-Diatrizoate at 12 h prior to the examination. All patients completed a questionnaire to indicate the time of onset of adverse effects and when they were most severe. Five advanced practitioners assessed the image quality in a visual grading study. Visual grading characteristic (VGC) analysis was applied with regime 1 as the reference condition and regime 2 and test condition; test alpha was set at 0.05.
RESULTS
Image quality was assessed with successful bowel cleansing as the scoring criteria for the visual grading study. The bowel cleansing as provided by the two Meglumine-Diatrizoate regimes was revealed not to be statistically different, with the area under the VGC curve and 95% confidence intervals 0.487 (0.287, 0.701), p = 0.887. Patients taking the 75:25 bowel preparation experienced a shorter median time to the onset of adverse effects.
CONCLUSION
There was no observed difference in Image quality criteria score for the two Meglumine-Diatrizoate based bowel preparation with more predictable adverse effects of Meglumine-Diatrizoate with the 75:25 preparation.
IMPLICATIONS FOR PRACTICE
Providing patients with a higher contrast burden 24 h prior to CTC may have a positive impact on the patient experience without compromising image quality.
Topics: Cathartics; Colonography, Computed Tomographic; Contrast Media; Diatrizoate Meglumine; Humans; Tomography
PubMed: 32376192
DOI: 10.1016/j.radi.2020.04.007 -
World Journal of Gastroenterology Dec 2017To assess the cleansing efficacy and safety of a new Colon capsule endoscopy (CCE) bowel preparation regimen. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To assess the cleansing efficacy and safety of a new Colon capsule endoscopy (CCE) bowel preparation regimen.
METHODS
This was a multicenter, prospective, randomized, controlled study comparing two CCE regimens. Subjects were asymptomatic and average risk for colorectal cancer. The second generation CCE system (PillCam COLON 2; Medtronic, Yoqneam, Israel) was utilized. Preparation regimens differed in the 1 and 2 boosts with the Study regimen using oral sulfate solution (89 mL) with diatrizoate meglumine and diatrizoate sodium solution ("diatrizoate solution") (boost 1 = 60 mL, boost 2 = 30 mL) and the Control regimen oral sulfate solution (89 mL) alone. The primary outcome was overall and segmental colon cleansing. Secondary outcomes included safety, polyp detection, colonic transit, CCE completion and capsule excretion ≤ 12 h.
RESULTS
Both regimens had similar cleansing efficacy for the whole colon (Adequate: Study = 75.9%, Control = 77.3%; = 0.88) and individual segments. In the Study group, CCE completion was superior (Study = 90.9%, Control = 76.9%; = 0.048) and colonic transit was more often < 40 min (Study = 21.8%, Control = 4%; = 0.0073). More Study regimen subjects experienced adverse events (Study = 19.4%, Control = 3.4%; = 0.0061), and this difference did not appear related to diatrizoate solution. Adverse events were primarily gastrointestinal in nature and no serious adverse events related either to the bowel preparation regimen or the capsule were observed. There was a trend toward higher polyp detection with the Study regimen, but this did not achieve statistical significance for any size category. Mean transit time through the entire gastrointestinal tract, from ingestion to excretion, was shorter with the Study regimen while mean colonic transit times were similar for both study groups.
CONCLUSION
A CCE bowel preparation regimen using oral sulfate solution and diatrizoate solution as a boost agent is effective, safe, and achieved superior CCE completion.
Topics: Administration, Oral; Aged; Capsule Endoscopy; Cathartics; Colon; Colonic Polyps; Colonoscopy; Diatrizoate; Female; Humans; Male; Middle Aged; Preoperative Care; Prospective Studies; Sulfates; Time Factors; Treatment Outcome
PubMed: 29358870
DOI: 10.3748/wjg.v23.i48.8615 -
Diseases of the Esophagus : Official... Oct 2017The objective of this systematic review is to identify key components of enhanced recovery protocols (ERP) that lead to improved length of hospital stay (LOS) following... (Comparative Study)
Comparative Study Meta-Analysis Review
The objective of this systematic review is to identify key components of enhanced recovery protocols (ERP) that lead to improved length of hospital stay (LOS) following esophagectomy. Relevant electronic databases were searched for studies comparing clinical outcome from esophagectomy followed by a conventional pathway versus ERP. Relevant outcome measures were compared and metaregression was performed to identify the key ERP components associated with reduced in LOS. Thirteen publications were included, ERP was associated with no changes in in-hospital mortality, total complications, anastomotic leak, or pulmonary complications compared with a conventional pathway, however LOS was reduced in the ERP group. Metaregression identified that immediate extubation was associated with reduced LOS (OR = -0.51, 95%CI -0.77 to -0.25; P < 0.01). Several postoperative factors were associated with a significant reduction in length of hospital stay, and in order of most important were (i) gastrograffin swallow ≤5 days (OR = -4.27, 95%CI -4.50 to -4.03); (ii) mobilization on postoperative day ≤1 (OR = -2.49, 95%CI -2.63 to -2.34); (iii) removal of urinary catheter ≤2 days (OR = -0.99, 95%CI -1.15 to -0.84); (iv) oral intake with at least sips of fluid ≤1 day (OR = -0.96, 95%CI -1.24 to -0.68); (v) enteral diet with feeding jejunostomy or gastrostomy ≤ 1 day (OR = -0.57, 95%CI -0.80 to -0.35) and (vi) epidural removal ≤ 4 days (OR = -0.17, 95%CI -0.27 to -0.07). Several core ERP components and principles appear to be associated with LOS reduction. These elements should form a part of the core ERP for the specialty, while surgical teams incorporate other elements through an iterative process.
Topics: Airway Extubation; Analgesia, Epidural; Contrast Media; Diatrizoate Meglumine; Drinking; Early Ambulation; Enteral Nutrition; Esophagectomy; Hospital Mortality; Humans; Length of Stay; Postoperative Care; Postoperative Complications; Time Factors; Urinary Catheterization
PubMed: 28859398
DOI: 10.1093/dote/dox090 -
World Journal of Gastrointestinal... Sep 2023Early postoperative inflammatory small bowel obstruction (EPISBO) is easy to be complicated after colorectal cancer surgery. Both intestinal obstruction catheter and...
BACKGROUND
Early postoperative inflammatory small bowel obstruction (EPISBO) is easy to be complicated after colorectal cancer surgery. Both intestinal obstruction catheter and meglumine can treat EPISBO.
AIM
To investigate the efficacy of an intestinal obstruction tube combined with meglumine diazo in treating EPISBO of colorectal cancer.
METHODS
Data from 60 patients with colorectal cancer and intestinal obstruction admitted to the Proctology Department of our hospital from April 2018 to May 2022 were collected and analyzed and divided into three cohorts according to different treatment regimens. Cohort A ( = 20) received a transnasal intestinal obstruction catheter with panumglumine, and cohort B ( = 20) received a transnasal intestinal obstruction catheter with liquid paraffin. Cohort C ( = 20) received oral treatment with meglumine. The clinical efficacy, first exhaust/defecation time, length of hospital stay, gastrointestinal decompression time, relief time of abdominal pain, and relief time of abdominal distension were compared among the three cohorts. The levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), serum albumin, and transferrin were compared among the three cohorts before and after treatment. The occurrence of adverse reactions in the three cohorts was compared.
RESULTS
Compared with cohort C, the successful treatment rate of cohort A was significantly higher. There were statistically significant variations in the time of first exhaust/defecation, length of hospital stays, gastrointestinal decompression time, relief time of abdominal pain, and relief time of abdominal distention among the three cohorts. Compared with cohort C, cohort A's first exhaust/defecation time, hospitalization time, gastrointestinal decompression time, abdominal pain relief time, and abdominal distension relief time was reduced ( < 0.05). After treatment, serum CRP, TNF-α, IL-6, and MCP-1 expression levels increased, and serum albumin and serum transferrin levels increased in the three cohorts. The serum albumin level in cohort A was higher than in cohort C. Compared with cohort B and cohort C, the serum transferrin level in cohort A increased ( < 0.05). Compared with cohort C, the total incidence of adverse reactions in cohorts A and B was significantly higher ( < 0.05). The incidence of adverse reactions was similar between cohort A and cohort B.
CONCLUSION
Using an ileus tube combined with meglumine diatrizoate can effectively treat postoperative inflammatory ileus obstructions after surgery colorectal cancer and improve prognosis, inflammatory response, and nutritional status.
PubMed: 37901727
DOI: 10.4240/wjgs.v15.i9.1950 -
International Endodontic Journal May 2020To explore in a laboratory setting the feasibility of using Meglumine Diatrizoate (MD) to improve the accuracy of diagnosis of cracked teeth on cone-beam CT (CBCT)...
AIM
To explore in a laboratory setting the feasibility of using Meglumine Diatrizoate (MD) to improve the accuracy of diagnosis of cracked teeth on cone-beam CT (CBCT) images.
METHODOLOGY
Twenty-four teeth were cracked artificially by soaking them cyclically in liquid nitrogen and hot water. The number and position of crack lines were evaluated with a dental operating microscope and used as the gold standard. The artificially cracked teeth were then examined using routine scanning (RS) and enhanced scanning (ES) modes, respectively. For the ES mode, MD was painted on the surface of the crack lines, and then, CBCT scanning with the same parameters was performed after 10 min. A radiological graduate student and an experienced radiologist evaluated the presence or absence of crack lines, respectively. The differences between the RS and ES modes were determined and assessed using McNemar's test. Inter-examiner agreement and intra-examiner agreement were assessed using kappa analysis.
RESULTS
Fifty-seven crack lines were found in the 24 cracked teeth. In the RS mode, the accuracy of detection of crack lines was 23% (radiological graduate student) and 32% (experienced radiologist), whereas in the ES mode, the accuracy was 61% (radiological graduate student) and 65% (experienced radiologist). The inter-examiner agreement was 0.693 in RS mode and 0.849 in ES mode. The intra-examiner agreement was 0.872 and 0.949 for the radiological graduate student in RS and ES mode respectively; and one for the experienced radiologist both in RS and ES mode.
CONCLUSIONS
Compared with routine scanning mode, more crack lines could be detected in enhanced scanning mode using Meglumine Diatrizoate as a contrast medium. MD could be a potential contrast medium to improve the accuracy of detection of crack lines on CBCT images.
Topics: Cone-Beam Computed Tomography; Diatrizoate Meglumine; Humans; Tooth; Tooth Fractures; Tooth Root
PubMed: 31985061
DOI: 10.1111/iej.13270 -
Internal Medicine (Tokyo, Japan) Mar 2024A 35-year-old man with fever and diarrhea visited our hospital because of white string-like fecal excretion. Based on a morphological examination of the excreted object,...
A 35-year-old man with fever and diarrhea visited our hospital because of white string-like fecal excretion. Based on a morphological examination of the excreted object, a Diphyllobothrium infection was suspected. Additionally, Gram staining of a fecal sample revealed Campylobacter infection. After the intraduodenal administration of meglumine/diatrizoate sodium, the tapeworm was excreted. A polymerase chain reaction-based DNA sequence analysis demonstrated that the tapeworm excreted in this case was Diphyllobothrium nihonkaiensis. This report presents a rare case of coinfection with Diphyllobothrium nihonkaiensis and Campylobacter jejuni. Therefore, it is important to consider the coexistence of other intestinal infections when diagnosing parasitic infections in patients with fever.
PubMed: 38462514
DOI: 10.2169/internalmedicine.3388-23 -
Gastroenterologia Y Hepatologia Oct 2022Achieving adequate bowel cleansing is of utmost importance for the efficiency of colon capsule endoscopy (CCE). However, information about predictive factors is lacking.... (Observational Study)
Observational Study
BACKGROUND AND AIMS
Achieving adequate bowel cleansing is of utmost importance for the efficiency of colon capsule endoscopy (CCE). However, information about predictive factors is lacking. The aim of this study was to assess the predictive factors of poor bowel cleansing in the CCE setting.
METHODS
In this observational study, 126 patients who underwent CCE at two tertiary care hospitals were included between June 2017 and January 2020. Participants prepared for bowel cleansing with a 1-day clear liquid diet, a 4-L split-dose polyethylene glycol regimen and boosters with sodium phosphate, sodium amidotrizoate and meglumine amidotrizoate. Domperidone tablets and bisacodyl suppositories were administered when needed. Overall and per-segment bowel cleansing was evaluated using a CCE cleansing score. Simple and multiple logistic regression analysis were carried out to assess poor bowel cleansing and excretion rate predictors.
RESULTS
Overall bowel cleansing was optimal in 53 patients (50.5%). Optimal per-segment bowel cleansing was achieved as follows: cecum (86 patients; 74.8%), transverse colon (91 patients; 81.3%), distal colon (81 patients; 75%) and rectum (64 patients; 66.7%). In the univariate analysis, elderly (OR, 1.03; 95% CI (1.01-1.076)) and constipation (OR, 3.82; 95% CI (1.50-9.71)) were associated with poor bowel cleansing. In the logistic regression analysis, constipation (OR, 3.77; 95% CI (1.43-10.0)) was associated with poor bowel cleansing. No variables were significantly associated with the CCE device excretion rate.
CONCLUSION
Our results suggest that constipation is the most powerful predictor of poor bowel cleansing in the CCE setting. Tailored cleansing protocols should be recommended for these patients.
Topics: Aged; Bisacodyl; Capsule Endoscopy; Cathartics; Colon; Colonoscopy; Constipation; Diatrizoate Meglumine; Domperidone; Humans; Polyethylene Glycols; Sodium; Suppositories
PubMed: 35065169
DOI: 10.1016/j.gastrohep.2022.01.003 -
Animal Cells and Systems 2021Constipation is a common disease that reduces life quality. Drugs of various mechanisms are being developed to resolve this affliction. Intestinal motility can be easily...
Constipation is a common disease that reduces life quality. Drugs of various mechanisms are being developed to resolve this affliction. Intestinal motility can be easily monitored in zebrafish, and so we selected this organism to develop a constipation model to measure drug-induced prokinetic effects. In this study, intestinal motility was monitored in zebrafish by tracking intestinal transit using fluorescence, after which an opioid-induced constipation model was established using loperamide. We then evaluated the prokinetic effect of diatrizoate meglumine (Gastrografin®), which has been empirically used to treat post-operative ileus or adhesive small bowel obstructions. Diatrizoate meglumine was effective in promoting bowel movements in an opioid-induced zebrafish constipation model and its prokinetic effect was associated with an increased expression of interstitial cells of Cajal (ICC) markers. Therefore, the loperamide-induced zebrafish constipation model developed herein is a promising tool to evaluate novel constipation therapies.
PubMed: 34745433
DOI: 10.1080/19768354.2021.1991472