臺灣博碩士論文加值系統

BACKGROUND: Colonoscopy, which is a medical procedure used to directly observe the whole inner lining mucosa of the colon, is now a standard method for evaluating of colorectal diseases. Oral bowel preparation is essential for successful colonoscopy examination. The quality of bowel preparation depends on several factors, and the bowel preparation agent is the most important factor in cleansing the whole colon lumen. At Cho Ray hospital, Endoscopy Department, Vietnam, PEG4000 (polyethylene glycol 4000) and PICOSULFATE are available and used interchangeable. Recently, the proportion of inadequate colon preparation is high, partially affecting the colonoscopy procedure that raises the need to look for a new alternative purgative agent. Therefore, we aim to compare the differences about the efficacy of cleaning colon, tolerance, and patient comfort by using PEG4000 and PICOSULFATE in our Endoscopy department, Cho Ray hospital, Vietnam.
OBJECTIVES: To compare the efficacy and tolerance of outpatients colonoscopy using PEG4000 and PICOSULFATE in the Endoscopy Department, ChoRay hospital, Vietnam in order to provide a good information for selecting an alternative colon preparation agent.
METHODS: In this randomized, prospective study, 253 consecutive adultpatients (133 males/120 Females) presenting foroutpatient colonoscopy at our endoscopy department, Cho Ray hospital were enrolled. Two regimens including 3 packages of PEG 4000 mixed with 3 liters of water (Group 1) and 1 package of PICOSULFATE mixed with 2 to 3 liters of water were (Group 2) used and evaluated. All patients completed the detailed questionnaires regarding the discormfort and pain using the visual analog scale of 10 cm methods in which 0 score is for “very poor” and 10 score is for “excellent” prior and during the colonoscopy.Bowel preparation was assessed using the Boston Bowel Preparation Scale by the endoscopist. Multivariate analysis was used to compare the two regimens and identify the patient-related factors that influenced the bowel preparation.
RESULTS: Between December 2014 and May 2015, 126 (49.8%) and 127 (50.2%) patients were randomized recruited and assigned for Group 1 and Group 2, respectively. The mean age of the patients was 53.86±15.03 years (range 18 to 82 years). All patients completed the study. PICOSULFATE is significant superior to PEG4000 in regarding to patients satisfaction and colon cleansing (mean score of 8.7 vs 7.4, p<0.001 and mean score of 8.0 vs 7.4, p<0.05, respectively). No significant difference between gender, occupation, educational level, kind of food used in the last meal, history of having bowel preparation, total volumes of water drinking as well as numbers of toilet using during preparation and colon cleansing degree was found (all p>0.05). Those who walked around had a significant better bowel cleansing than those sitting down during colon preparation (mean score of 7.9 vs 7.4, p<0.05). Adverse effects such as nausea, vomiting, headache, vertigo, and sweating were not significant difference between the two groups, however, the proprotion of abdominal pain in patients using PICOSULFATE was significant lower than that in those using PEG4000 (6.2% vs 19.8%, p<0.05).
CONCLUSIONS: PICOSULFATE is more efficacious and comfortable for the patients than PEG4000 in colon preparation prior to colonoscopy in outpatient, in the Endoscopy department, Cho Ray hospital, Vietnam. Regarding the high quality of bowel cleansing and fewer side effects, PICOSULFATE is suggested as an alternative purgative agent to PEG4000 in our daily clinical practice in Cho Ray hospital, Vietnam.

Chapter 1 Introduction..................................7
1.1 Definition of colonoscopy..........................7
1.2 Indications of colonoscopy.........................7
1.3 Background.........................................9
1.4 Aim(s) of study...................................10
Chapter 2. Objectives................................11
2.1 Main objective....................................11
2.2 Intermediate objectives:..........................11
Chapter 3. Review of the literature..................12
3.1 General overview..................................12
3.2 Colonoscopy preparation...........................12
3.3 Patient characteristics...........................18
3.4 Indication for colonoscopy........................20
3.5 Prior poor preparation............................21
3.6 Timing of administration..........................21
3.7 Specific preparations.............................23
3.8 Flexible sigmoidoscopy preparation................33
Chapter 4. Research methodology......................35
4.1 Study design......................................35
4.2 Study setting/location............................35
4.3 Hypothesis........................................35
4.4 Study population..................................35
4.5 Eligibility criteria..............................36
4.6 Study procedures..................................37
4.7 Statistical considerations and data analysis......39
4.8 Ethical considerations............................39
Chapter 5. Results...................................41
5.1 Demographic characteristic........................41
5.2 Regime for the day precede the endoscopy..........51
5.3 Clinical symptoms after using endoscopy preparation products..................................................57
5.4 Patient’s comfort during the preparation phase...68
5.5 Patient's pain during the colonoscopy procedure...71
5.6 Endoscopy results.................................74
Chapter 6. Discussions...............................80
6.1 Interpretation of finding.........................80
6.2 Randomization of sample...........................86
6.3 Strengths and limitations.........................87
6.4 Implications for further research.................88
Chapter 7. Annexes...................................89
7.1 Questionnaire.....................................89
Chapter 8. References................................91

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