Majid Alsahafi

Low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate, and clear liquid diet alone prior to small bowel capsule endoscopy

AIM To compare low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate and clear liquid diet alone as bowel preparation prior to small bowel capsule endoscopy (CE). METHODS We retrospectively collected all CE studies done from December 2011 to July 2013 at a single institution. CE studies were reviewed only if low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate or clear liquid diet alone used as the bowel preparation. The studies were then reviewed by the CE readers who were blinded to the preparation type. Cleanliness and bubble burden were graded independently within the proximal, middle and distal small bowel using a four-point scale according to the percentage of small bowel mucosa free of debris/bubbles: grade 1 = over 90%, grade 2 = between 90%-75%, grade 3 = between 50%-75%, grade 4 = less than 50%. Data are expressed as mean ± SEM. ANOVA and Fishers exact test were used where appropriate. P values < 0.05 were considered statistically significant. RESULTS A of total of 123 CE studies were reviewed. Twenty-six studies were excluded from analysis because of incomplete small bowel examination. In the remaining studies, 39 patients took low volume polyethylene glycol with ascorbic acid, 31 took sodium picosulfate-magnesium citrate and 27 took a clear liquid diet alone after lunch on the day before CE, followed by overnight fasting in all groups. There was no significant difference in small bowel cleanliness (1.98 ± 0.09 vs 1.84 ± 0.08 vs 1.76 ± 0.08) or small bowel transit time (213 ± 13 vs 248 ± 14 ± 225 ± 19 min) for clear liquid diet alone, MoviPrep and Pico-Salax respectively. The bubble burden in the mid small bowel was significantly higher in the MoviPrep group (1.6 ± 0.1 vs 1.9 ± 0.1 vs 1.6 ± 0.1, P < 0.05). However this did not result in a significant difference in diagnosis of pathology. CONCLUSION There was no significant difference in small bowel cleanliness or diagnostic yield of small bowel CE between the three preparations regimens used in this study.

Endoscopic Assisted Enucleation of Small Gastric Subepithelial Lesions: An Early Single Center Experience

© The Author(s) 2018. Published by Oxford University Press on behalf of the Canadian Association of Gastroenterology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Letter to Editor

The Effect of Prucalopride on Small Bowel Transit Time in Hospitalized Patients Undergoing Capsule Endoscopy

Background The inpatient status is a well-known risk factor for incomplete video capsule endoscopy (VCE) examinations due to prolonged transit time. We aimed to evaluate the effect of prucalopride on small bowel transit time for hospitalized patients undergoing VCE. Methods We included all hospitalized patients who underwent VCE at a tertiary academic center from October 2011 through September 2016. A single 2 mg dose of prucalopride was given exclusively for all patients who underwent VCE between March 2014 and December 2015. VCE studies were excluded if the capsule was retained or endoscopically placed, if other prokinetic agents were given, in cases with technical failure, or if patients had prior gastric or small bowel resection. Results 442 VCE were identified, of which 68 were performed in hospitalized patients. 54 inpatients were included, of which 29 consecutive patients received prucalopride. The prucalopride group had a significantly shorter small bowel transit time compared to the control group (92 versus 275.5, p < 0.001). There was a trend for a higher completion rate in the prucalopride group (93.1% versus 76%, p = 0.12). Conclusions Our results suggest that the administration of prucalopride prior to VCE is a simple and effective intervention to decrease small bowel transit time.

Circulating proplatelets in a patient with acute blood loss following liver transplantation

A 66-year-old female, diagnosed with autoimmune hepatitis and end-stage liver disease, underwent liver transplantation. Perioperative blood loss and coagulopathy were managed with intraoperative blood salvage, crystalloid infusion and transfusion of large quantities of erythrocytes, fresh frozen plasma, cryoprecipitate and platelets. Postoperatively, her full blood count showed haemoglobin concentration 64 g/l and platelet count 65 9 10/l. Examination of the blood film showed that about 30% of the platelets had proplatelet morphology (image): elongated, dumbbell, stretched and ‘winged’ forms. These proplatelets were not detectable in the blood film the next day and beyond. Current evidence, based on imaging studies on megakaryocyte cultures and animal experiments, supports a twostage platelet production model (Thon & Italiano, 2012). In the first stage, the proplatelets are released by megakaryocytes as stretched cytoplasmic extensions into the sinusoids and blood vessels of bone marrow and other organs. These proplatelets have elongated or dumbbell morphology; the cytoplasm connecting two bulbous ends continues to stretch and disrupts. In the second stage, the platelet cytoplasm retracts and they attain their mature discoid shape. In animal studies, proplatelet production increases significantly in conditions of stimulated megakaryopoiesis, such as acute blood loss or acute immune thrombocytopenia, when they may be seen in the blood. Proplatelets in the blood have been rarely reported in patients with immune thrombocytopenia. This case demonstrates that proplatelets can also be transiently seen in patients with acute blood loss.