Juan-Salvador Baudet

Cat scratch colon (CSC) is an entity characterized by bright red linear tears which appear in the colonic mucosa during colonoscopy. Although they do not generally have clinical implications, cases of secondary pneumoperitoneum have been reported. To date, the prevalence, associated diseases, and factors that determine the appearance of CSC have not been adequately determined. We report a series of 20 cases of CSC found in 10715 consecutive colonoscopies. Demographic data, indication for the colonoscopy, endoscopy findings, and complications related to the procedure were recorded. Older age and male sex were significantly associated with CSC. In 15 of the 20 cases the CSC was related to diversion colitis, and 5 cases appeared in patients with collagenous colitis. In patients with diversion colitis, the longer the time elapsed since surgery, the greater the risk of these lesions occurring. None of the patients with CSC had complications related to the colonoscopy.

Aim The aim of this research was to assess how the use of sedation during colonoscopy influences patient anxiety, fear, satisfaction, and acceptance of repeat examinations. Materials and methods A prospective case–control study quantifying the anxiety and fears of patients appointed for colonoscopy, comparing patients who had undergone previous colonoscopies with sedation (cases) with patients who had undergone previous colonoscopies without sedation and patients who had never had a colonoscopy before (controls). Following the examination, patients answered a satisfaction survey and were asked whether they would be willing to undergo future colonoscopies. Results The study included 2016 patients (average age 50.05±14.44 years; 47% men). Of these, 1270 patients (63%) were undergoing colonoscopy for the first time and 746 (37%) had undergone the procedure before; in the latter group, 313 patients (42%) had been provided sedation, whereas 433 (58%) had not. Patients who had been sedated for prior colonoscopies assigned significantly lower scores than patients who had undergone previous colonoscopies without sedation and those undergoing the procedure for the first time both in the anxiety survey (3.3±2.5 vs. 7.5±2.8 vs. 10.3±3.5; PPP<0.001). Conclusion Sedation reduces the anxiety and fear of undergoing a repeat colonoscopy and improves both patient satisfaction and the acceptability of future procedures.

The degree of Knower and compliance with occupational risk prevention measures in the Spanish gastrointestinal endoscopy units is unknown. 1. To assess compliance with occupational risk prevention measures in GIE units. 2. To determine which factors influence the fulfillment of occupational risk prevention measures. a validated survey was supplied to 300 GIE units, including questions on: 1. General occupational risk prevention measures; 2. occupational risk prevention measures during disinfection; 3. occupational risk prevention measures during examination. The following Hospital or GIE Unit characteristics were evaluated: Type of hospital according to the Spanish National Health Service; Number of hospital beds; Advanced diagnostic and therapeutic procedures performed and; Centers providing training in the field of endoscopy. response: 196 GIE units (65%). 104 GIE units (53% CI95%: 46-60) fulfill less than 50% of the occupational risk prevention measures studied.The RR of less than 50% of the ORP measures being fulfilled is 1.975 times higher at public hospitals than at private facilities (CI95%: 1.11-3.52). None of the remaining factors analyzed proved to have a significant influence. compliance with occupational risk prevention measures in Spanish GIE units is inadequate and must be improved. Public hospitals in Spain comply with fewer occupational risk prevention measures than their private counterparts.

A 32-year-old immigrant woman presented with abdominal pains, nausea, and vomiting. She had not been able to expel gas or feces for 5 days. She had had constipation since birth and had experienced many episodes similar to the current bout. The patient had been hospitalized during infancy in her country, but the cause for her complaint had not been identified. She regularly took laxatives as required. On examination, her abdomen was bloated and tympanic with diffuse tenderness. The rest of the examination and laboratory tests were normal. An abdominal radiograph ([ Fig. 1 ]) and computed tomography scan ([ Fig. 2 ]) showed a dilated ascending and transverse colon, and oval lesions with a radiopaque peripheral ring in the upper left quadrant. Colonoscopy ([ Fig. 3 ]) revealed stenosis of the splenic flexure, which was covered by normal mucosa. The patient underwent surgical resection. Histological studies revealed a normal colon with a 2-cm concentric stenosis of the wall and hypertrophy of the muscular layer. There were no inflammatory, ischemic, or neoplastic changes, or changes in the nerve plexuses, but calcified fecalomas were seen proximally. At 12 months of follow-up, the patient remains asymptomatic with daily bowel movements that do not require taking laxatives. Fig. 1 Abdominal radiograph showing calcified fecalomas at the splenic flexure (arrows). Fig. 2 Axial computed tomography (CT) scan showing calcified fecalomas at the splenic flexure (arrows). Fig. 3 Colonoscopy showing benign stenosis of the splenic flexure. Congenital stenosis can affect any section of the colon, although it most often occurs in the ascending and transverse segments. Its clinical manifestations are usually chronic constipation and obstructive episodes [ 1 ] [ 2 ], and it generally is treated by surgical resection within 24 months of birth [ 3 ]. In our case, the onset of the symptoms in the neonatal period, the absence of a clinical or pathoanatomical history of inflammatory or ischemic abdominal processes, and the presence of calcified fecalomas suggested a diagnosis of congenital colonic stenosis that had not been identified during infancy. To our knowledge, it is the first report of congenital stenosis diagnosed in adulthood. Competing interests: None Endoscopy_UCTN_Code_CCL_1AD_2AJ

Gastrointestinal endoscopy causes discomfort and pain in patients. Sedation reduces anxiety and pain. Its use, however, continues to be a controversial issue and it varies greatly from one country to another. The use of sedation in Spanish gastrointestinal endoscopy (GIE) units is unknown. To determine the use of sedation in Spanish GIE units. A 24-question survey on the use of sedation was distributed among 300 Spanish GIE units. Surveys were answered by 197 GIE units (65%), which had performed 588,326 endoscopies over the past 12 months. Sedation was used in more than 20% of gastroscopies performed at 55% of the GIE units, and more than 20% of colonoscopies were sedated at 71% of the units; endoscopic retrograde cholangiopancreatography (ERCP) is almost always performed under sedation. The most common drugs were midazolam for gastroscopy and midazolam and pethidine for colonoscopy and ERCP; propofol is used by anesthetists; pulse oximetry is used at 77% of GIE units; 42% of the GIE units fill in a nursing record; 52% of GIE units have recovery rooms and 91% have a cardiac arrest trolley. The use of sedation in endoscopy varies greatly in Spain. It is seldom used in gastroscopy; it is more frequent in colonoscopy, and in ERCP it is the norm. In most GIE units sedation is controlled by the endoscopist with pulse oximetry. The most commonly used drugs are benzodiazepines, on their own for gastroscopy and combined with opioids for colonoscopy and ERCP.

Minor complications in colonoscopy, such as pain, distension, headache, dizziness, etc. are an important cause for the rejection of colonoscopy procedure. Their incidence, however, has not been established. To determine minor complication rates in outpatient colonoscopy procedures and the effect of sedation on these complications. A prospective randomized cohort study was performed on 1250 adults selected randomly among patients referred to our endoscopy unit. Complications and undesirable affects related to the colonoscopy were reordered during the patients' stay in the endoscopy unit (early complications) and 30 days postprocedure (late complications). One thousand one hundred and twenty-six patients were enrolled (mean age 50.43+/-13.7 years; 54.5% female), of which 875 (78%) were sedated and 251 (22%) were not. No difference between groups was observed. Thirty-one percent of the patients had early minor complications (25% among sedated patients; 52% of nonsedated patients; P<0.001 chi2); 23% had late minor complications (16% of sedated patients vs. 51% nonsedated patients; P<0.001 chi2). The most common undesirable effects were pain and abdominal distension. The risk of experiencing complications - odds ratio - was 1.013 times higher per year of age [confidence interval (CI) 95%: 1.004-1.022]; 1.953 times higher per increase in American Society of Anesthesiologists classification (95% CI: 1.524-2.504); and 0.116 times lower when sedation was used (95% CI: 0.079-0.170). Minor complications of colonoscopy are common. Their incidence increases with age and American Society of Anesthesiologists class and decreases with the use of sedation.