Assessment of postoperative gastrointestinal motility in colorectal surgery: a study with the Motilis 3D-transit system

2020 ◽  
Vol 7 (1) ◽  
pp. 53-60
Author(s):  
Jesper Nors ◽  
Mette Winther Klinge ◽  
Thorbjørn Sommer ◽  
Søren Laurberg ◽  
Klaus Krogh ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Transit Time ◽  
Primary Anastomosis ◽  
Postoperative Recovery ◽  
University Hospital ◽  
Double Blind ◽  
Transit System ◽  
Study Region ◽  
Gi Transit ◽  
Gi Motility

PurposePostoperative recovery following colorectal surgery remains impaired by severe complications including postoperative ileus (POI). Human studies of POI have been limited by a lack of safe and easy-to-use objective methods. Motilis 3D-transit is a completely ambulatory, minimally invasive system whereby electromagnetic capsules are followed by external sensors during their passage of the gastrointestinal (GI) tract. The aim of this study was to evaluate the applicability of the 3D-transit system in a surgical setting.MethodWe included 12 patients as a substudy of the randomised double blind controlled Stimulation of the Autonomic Nervous System In Colorectal Surgery by perioperative nutrition (SANICS)-II trial undergoing elective segmental colonic resection with primary anastomosis at Aarhus University Hospital and Randers Regional Hospital, Denmark. To study region-specific motility, three electromagnetic capsules were administered. One was taken 3 hours before surgery, the next was taken 1 hour before surgery, while the third was placed distal to the anastomosis during surgery. Total and regional GI transit times as well as time until first propulsive colonic contraction were determined.ResultsAll patients tolerated the setup well with no adverse events related to the 3D-transit system. Large variations were found in total GI transit time (26.7–127.6 hours), gastric emptying (0.07–>106.9 hours), small intestinal (1.2–58.4 hours) and colorectal transit time (14.3–>118.1 hours). Time from end of surgery to first propulsive movement in the colon varied from 3.9 to 85 hours. No correlation was found between parameters of GI motility and tolerance of an oral diet or recovery of bowel function.ConclusionThe 3D-transit system allows safe assessment of GI motility in patients operated with segmental colonic resections and primary anastomosis for colorectal cancer. Postsurgical motility varies significantly between patients.

The impact of naloxegol treatment on gastrointestinal transit and colonic volume

2017 ◽  
Vol 16 (1) ◽  
pp. 172-172
Author(s):  
D. Grønlund ◽  
A.E. Olesen ◽  
J.L. Poulsen ◽  
C. Brock ◽  
A.M. Drewes
Keyword(s):  
Experimental Model ◽  
Transit Time ◽  
Gastrointestinal Transit ◽  
Receptor Activation ◽  
Opioid Antagonist ◽  
Imaging Method ◽  
Transit System ◽  
Gi Symptoms ◽  
Gi Transit ◽  
The Impact

Abstract Aims Opioid treatment is associated with gastrointestinal (GI) side effects, known as opioid-induced bowel dysfunction (OIBD). Symptoms of OIBD are caused by opioid receptor activation in the enteric nervous system, which results in increased GI transit time and increased faecal volume in the colon. OIBD can be experimentally induced in healthy participants through oral oxycodone treatment. The aim of this study was to investigate whether administration of naloxegol, a peripherally restricted opioid antagonist, could reduce GI symptoms, GI transit time, and colorectal volume, using an experimental model of OIBD. Methods In a double blind crossover trial, twenty-five healthy males were randomly assigned to a six day treatment of oral oxycodone in combination with either oral naloxegol or placebo. At baseline and at day six, participants filled in the Patient Assessment of Constipation Symptom questionnaire, and colorectal volume was quantified with a magnetic resonance imaging method. Participants swallowed a small electromagnetic capsule, which allowed determination of total and segmental GI transit times, using the 3D-Transit system. Results In the established model of oxycodone induced OIBD, fewer GI symptoms were observed during naloxegol treatment, compared to placebo (P <0.01). Naloxegol decreased median total transit time by 27% (56 vs 71 h, P < 0.05) and decreased colorectal transit time by 33% (45 vs 59 h, P < 0.01), compared to placebo. No difference in colorectal volume was found between the two treatments. Conclusions In an experimental model of OIBD, GI symptoms and GI transit time were reduced during treatment with naloxegol, compared to placebo. However, naloxegol treatment did not reduce colorectal volume. These findings add information on the potential of naloxegol to be used in prevention and treatment of OIBD.

scholarly journals The impact of opioid treatment on regional gastrointestinal transit

2016 ◽  
Vol 12 (1) ◽  
pp. 126
Author(s):  
D. Jørgensen ◽  
J.L. Poulsen ◽  
A.E. Olesen ◽  
C. Brock ◽  
T.H. Sandberg ◽  
...  
Keyword(s):  
Transit Time ◽  
Rating Scale ◽  
Gastrointestinal Transit ◽  
Transit System ◽  
Opioid Treatment ◽  
Gastrointestinal Symptom Rating Scale ◽  
Transit Times ◽  
Gi Symptoms ◽  
Gi Transit ◽  
The Impact

AbstractAimsTo employ a human experimental model of opioid-induced bowel dysfunction (OIBD) in healthy volunteers, and evaluate the impact of opioid treatment compared to placebo on gastrointestinal (GI) symptoms and motility, assessed by questionnaires and regional GI transit times.MethodsTwenty-five healthy males were randomly assigned to oxycodone or placebo for five days in a double-blind, crossover design. Adverse GI effects were measured with bowel function index, gastrointestinal symptom rating scale, patient assessment of constipation symptoms questionnaire, and bristol stool form scale. Regional GI transit times were determined using the 3D-Transit system and segmental colonic transit times were determined using a custom Matlab® graphical user interface.ResultsGI symptom scores increased significantly across all applied questionnaires during opioid treatment. Oxycodone increased median total GI transit time from 22.2 to 43.9 h (P< 0.01), segmental transit times in the cecum and ascending colon from 5.7 to 9.9 h (P<0.05), rectosigmoid transit time from 2.7 to 9.0 h (P<0.05), and colorectal transit time from 18.6 to 38.6 h (P<0.01). No association between questionnaire scores and segmental transit times were detected.ConclusionsSelf-assessed adverse GI effects and increased GI transit times in different segments were induced during oxycodone treatment. This detailed information about segmental changes in motility has great potential for future interventional head-to-head trials of different laxative regimes for prevention and treatment of OIBD.

scholarly journals Identifying and Treating Opioid Side Effects

2019 ◽  
Vol 130 (1) ◽  
pp. 142-148 ◽  
Author(s):  
Jonathan Moss
Keyword(s):  
Placebo Group ◽  
Transit Time ◽  
Methadone Maintenance ◽  
Controlled Trial ◽  
Intervention Group ◽  
Treated Group ◽  
Opioid Withdrawal ◽  
University Hospital ◽  
Double Blind ◽  
Opioid Administration

Abstract Methylnaltrexone Reverses Chronic Opioid-induced Constipation: A Randomized, Controlled Trial. By Yuan CS, Foss JF, O’Connor M, Osinski J, Karrison T, Moss J, Roizen MF. JAMA 2000; 130:142–8. Reprinted with permission. Context Constipation is the most common chronic adverse effect of opioid pain medications in patients who require long-term opioid administration, such as patients with advanced cancer, but conventional measures for ameliorating constipation often are insufficient. Objective To evaluate the efficacy of methylnaltrexone, the first peripheral opioid receptor antagonist, in treating chronic methadone-induced constipation. Design Double-blind, randomized, placebo-controlled trial conducted between May 1997 and December 1998. Setting Clinical research center of a university hospital. Participants Twenty-two subjects (9 men and 13 women; mean [SD] age, 43.2 [5.5] years) enrolled in a methadone maintenance program and having methadone-induced constipation. Main Outcome Measures Laxation response, oral-cecal transit time, and central opioid withdrawal symptoms were compared between the 2 groups. Results The 11 subjects in the placebo group showed no laxation response, and all 11 subjects in the intervention group had laxation response after intravenous methylnaltrexone administration (P&lt;.001). The oral-cecal transit times at baseline for subjects in the methylnaltrexone and placebo groups averaged 132.3 and 126.8 minutes, respectively. The average (SD) change in the methylnaltrexone-treated group was −77.7 (37.2) minutes, significantly greater than the average change in the placebo group (−1.4 [12.0] minutes; P&lt;.001). No opioid withdrawal was observed in any subject, and no significant adverse effects were reported by the subjects during the study. Conclusions Our data demonstrate that intravenous methylnaltrexone can induce laxation and reverse slowing of oral cecal-transit time in subjects taking high opioid dosages. Low-dosage methylnaltrexone may have clinical utility in managing opioid-induced constipation.

scholarly journals Patient-reported recovery in upper abdominal cancer surgery care: A prospective study

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110169
Author(s):  
Anna Johansson ◽  
Jessica Karlsson ◽  
Victoria Fomichov ◽  
Anna Lindhoff Larsson ◽  
Per Sandström ◽  
...  
Keyword(s):  
Physical Symptoms ◽  
Postoperative Recovery ◽  
Cancer Surgery ◽  
Social Dimension ◽  
University Hospital ◽  
Care Process ◽  
Five Dimensions ◽  
Patient Reported ◽  
Upper Abdominal ◽  
A Prospective Study

The study aimed to describe and analyse patient-reported recovery in patients after upper abdominal cancer surgery. This study had a quantitative design and patients were consecutively included in a university hospital in southern Sweden. Twenty-four patients answered the Postoperative Recovery Profile (PRP) questionnaire at three measurement points. All five dimensions were affected. In the physical symptoms dimension, the majority of patients reported a lack of energy upon discharge. High levels of anxiety were reported. Over 50% of patients reported some degree of depressed mood at all three measurement points. In the social dimension, the majority of patients reported some degree of being dependent on help from others in everyday life at 4 weeks after discharge. Few patients are fully recovered at 4 weeks after discharge. Individual patient-reported recovery estimates may be valuable in identifying and planning interventions tailored to each patient’s needs throughout the care process.

scholarly journals Acute Effects of Triiodothyronine on Endothelial Function in Human Subjects

2007 ◽  
Vol 92 (1) ◽  
pp. 250-254 ◽  
Author(s):  
Raffaele Napoli ◽  
Vincenzo Guardasole ◽  
Valentina Angelini ◽  
Emanuela Zarra ◽  
Daniela Terracciano ◽  
...  
Keyword(s):  
Endothelial Function ◽  
Dose Response ◽  
Vascular Reactivity ◽  
Controlled Trial ◽  
University Hospital ◽  
Acute Effects ◽  
Response Curves ◽  
Double Blind ◽  
Low T3 ◽  
Dose Response Curves

Abstract Context: Thyroid hormone regulates several cardiovascular functions, and low T3 levels are frequently associated with cardiovascular diseases. Whether T3 exerts any acute and direct effect on endothelial function in humans is unknown. Objective: Our objective was to clarify whether acute changes in serum T3 concentration affect endothelial function. Design, Setting, and Subjects: Ten healthy subjects (age, 24 ± 1 yr) participated in a double-blind, placebo-controlled trial at a university hospital. Interventions: T3 (or placebo) was infused for 7 h into the brachial artery to raise local T3 to levels observed in moderate hyperthyroidism. Vascular reactivity was tested by intraarterial infusion of vasoactive agents. Main Outcome Measures: We assessed changes in forearm blood flow (FBF) measured by plethysmography. Results: FBF response to the endothelium-dependent vasodilator acetylcholine was enhanced by T3 (P = 0.002 for the interaction between T3 and acetylcholine). The slopes of the dose-response curves were 0.41 ± 0.06 and 0.23 ± 0.04 ml/dl·min/μg in the T3 and placebo study, respectively (P = 0.03). T3 infusion had no effect on the FBF response to sodium nitroprusside. T3 potentiated the vasoconstrictor response to norepinephrine (P = 0.006 for the interaction). Also, the slopes of the dose-response curves were affected by T3 (1.95 ± 0.77 and 3.83 ± 0.35 ml/dl·min/mg in the placebo and T3 study, respectively; P &lt; 0.05). The increase in basal FBF induced by T3 was inhibited by NG-monomethyl-l-arginine. Conclusions: T3 exerts direct and acute effects on the resistance vessels by enhancing endothelial function and norepinephrine-induced vasoconstriction. The data may help clarify the vascular impact of the low T3 syndrome and point to potential therapeutic strategies.

Value of Whole-Body Washing With Chlorhexidine for the Eradication of Methicillin-ResistantStaphylococcus aureus:A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

2007 ◽  
Vol 28 (9) ◽  
pp. 1036-1043 ◽  
Author(s):  
C. Wendt ◽  
S. Schinke ◽  
M. Württemberger ◽  
K. Oberdorfer ◽  
O. Bock-Hensley ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Placebo Group ◽  
Treatment Group ◽  
Solution Treatment ◽  
University Hospital ◽  
Whole Body ◽  
Double Blind ◽  
Antiseptic Solution ◽  
Double Blind Clinical Trial ◽  
Double Blinded

Background.Whole-body washing with antiseptic solution has been widely used as part of eradication treatment for colonization with methicillin-resistantStaphylococcus aureus(MRSA), but evidence for the effectiveness of this measure is limited.Objective.To study the efficacy of whole-body washing with chlorhexidine for the control of MRSA.Design.Randomized, placebo-controlled, double-blinded clinical trial.Setting.University Hospital of Heidelberg and surrounding nursing homes.Patients.MRSA carriers who were not treated concurrently with antibiotics effective against MRSA were eligible for the study.Intervention.Five days of whole-body washing with either 4% chlorhexidine solution (treatment group) or with a placebo solution. All patients received mupirocin nasal ointment and chlorhexidine mouth rinse. The outcome was evaluated 3, 4, 5, 9, and 30 days after treatment with swab samples taken from several body sites.Results.Of 114 patients enrolled in the study (56 in the treatment group and 58 in the placebo group), 11 did not finish treatment (8 from the treatment group and 3 from the placebo group [P= .02]). At baseline, the groups did not differ with regard to age, sex, underlying condition, site of MRSA colonization, or history of MRSA eradication treatment. Eleven patients were MRSA-free 30 days after treatment (4 from the treatment group and 7 from the placebo group [P= .47]). Only groin-area colonization was significantly better eradicated by the use of chlorhexidine. The best predictor for total eradication was a low number of body sites positive for MRSA. Adverse effects were significantly more frequent in the treatment group than in the placebo group (any symptom, 71% vs 33%) but were reversible in most cases.Conclusion.Whole-body washing can reduce skin colonization, but it appears necessary to extend eradication measures to the gastrointestinal tract, wounds, and/or other colonized body sites if complete eradication is the goal.Trial Registration.ClinicalTrials.gov identifier: NCT00266448.

Prospective Surveillance Effectively Reduced Rates of Surgical Site Infection Associated With Elective Colorectal Surgery at a University Hospital in Japan

2006 ◽  
Vol 27 (5) ◽  
pp. 526-528 ◽  
Author(s):  
Tsuyoshi Konishi ◽  
Toshiaki Watanabe ◽  
Keita Morikane ◽  
Kazuhiko Fukatsu ◽  
Joji Kitayama ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
University Hospital ◽  
Site Infection ◽  
Prospective Surveillance ◽  
Elective Colorectal Surgery ◽  
Nationwide Surveillance ◽  
Surveillance Database

At a university hospital in Japan, the introduction of prospective surveillance and subsequent interventions was effective in reducing the rate of surgical site infection associated with elective colorectal surgery from 27.5% to 17.8% of surgeries. Japan should both recognize the importance of broader surveillance for surgical site infection and establish its own nationwide surveillance database.

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