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Chen HY, Tu MH, Chen MY. Effectiveness of a Mobile Health Application for Educating Outpatients about Bowel Preparation. Healthcare (Basel) 2024; 12:1374. [PMID: 39057517 PMCID: PMC11275862 DOI: 10.3390/healthcare12141374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Colonoscopy is an essential method for diagnosing and treating colorectal cancer, relying on effective bowel preparation to thoroughly examine the large intestinal mucosa. Traditional education involves printed instructions and verbal explanations but does not guarantee clear patient understanding. Poor bowel preparation can obscure mucosal visibility, delaying cancer diagnosis and treatment. A mobile medical model using Android devices for bowel preparation education was tested in a single-blind, randomized trial. This trial enrolled outpatients undergoing colonoscopy at the Endoscopy Center for Diagnostic and Treatment between 27 October 2021 and 31 December 2022. This study introduced the ColonClean app alongside traditional methods. After examination, endoscopists rated the preparation quality using the Aronchick scale. A data analysis was conducted using SPSS 25.0 to determine if there was a significant improvement in bowel preparation quality between the control group (traditional method) and the experimental group (traditional method plus the ColonClean app). Forty patients were recruited in each group. In the experimental group, all ratings were "fair", with 75% receiving an "excellent" or "good" rating, showing statistical significance (p = 0.016). The ColonClean app improves bowel preparation quality more effectively than traditional care instructions.
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Affiliation(s)
- Hui-Yu Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (H.-Y.C.); (M.-Y.C.)
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Ming-Hsiang Tu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (H.-Y.C.); (M.-Y.C.)
| | - Miao-Yen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (H.-Y.C.); (M.-Y.C.)
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Aragona SE, Spada C, DE Luca L, Aragona E, Ciprandi G. Probiotics for managing patients after bowel preparation for colonoscopy: an interventional, double-arm, open, randomized, multi-center, and national study (COLONSTUDY). Minerva Gastroenterol (Torino) 2024; 70:187-196. [PMID: 38818860 DOI: 10.23736/s2724-5985.24.03630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Bowel preparation (BP) for colonoscopy induces significant changes in gut microbiota, causing dysbiosis that, in turn, elicits intestinal symptoms. Consequently, probiotics may counterbalance the disturbed microbiota after BP. So, probiotics may restore microbiota homeostasis. METHODS The current study evaluated the efficacy and safety of Abincol®, an oral nutraceutical containing a probiotic mixture with Lactobacillus plantarum LP01 (1 billion living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 millions living cells), and Lactobacillus delbrueckii LDD01 (200 millions living cells), Patients were randomized in two groups (2:1). Group A took one stick/daily for four weeks after colonoscopy. Group B was considered as control. Patients were evaluated at baseline (T0) and after one (T1), two (T2), and four (T3) weeks. The severity of symptoms was measured by patients using a Visual Analog Scale. RESULTS Abincol® significantly diminished the presence and the severity of intestinal symptoms at T2 and even more at T3. All patients well tolerated the probiotic mixture. CONCLUSIONS The present study suggests that Abincol® may be considered an effective and safe therapeutic option in managing patients undergoing BP. The course should last one month.
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Affiliation(s)
- Salvatore E Aragona
- Unit of General Surgery, ASST Melegnano Martesana Presidio Melzo, Milan, Italy
| | - Cristiano Spada
- Unit of Digestive Endoscopy, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Luca DE Luca
- Unit of Gastroenterology and Digestive Endoscopy, ASST Santi Paolo e Carlo, Milan, Italy
| | - Elena Aragona
- Unit of General Surgery, ASST Melegnano Martesana Presidio Melzo, Milan, Italy
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Zhang YY, Vimala R, Chui PL, Hilmi IN. A Systematic Review of Exercise Therapy for Bowel Preparation: Evidence to Guide Practice. Gastroenterol Nurs 2023; 46:393-403. [PMID: 37347807 DOI: 10.1097/sga.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023] Open
Abstract
This systematic review aims to evaluate (1) the effectiveness of exercise therapy in bowel preparation for colonoscopy, and (2) the characteristics of exercise programs for bowel preparation. Systematic searches were done in PubMed, EMBASE, the Cochrane Library, Web of Science, and CINAHL from inception to November 2022. Randomized controlled trials and quasi-experimental studies assessing the efficacy of exercise during bowel preparation were included in this review. Two reviewers independently assessed the methodological quality using a modified Downs and Black checklist. A narrative synthesis was conducted. A total of five studies (1,109 participants) were included in this review. In all eligible studies, the characteristics of the exercise programs varied and included mainly two types of exercise (walking and yoga), various amount of exercise (3,000-10,000 steps or 0.5-1.9 hours), and two exercise timing (during and 1 hour after taking the laxative). Available evidence indicated that exercise therapy is effective in improving the quality of bowel preparation. However, there was insufficient high-quality evidence to conclude the effects on procedure-related indicators, adverse events, and willingness to repeat preparation. Exercise should be recommended as an important part of routine bowel preparation for patients undergoing colonoscopy to improve the quality of bowel preparation. More rigorous studies focusing on the effects on procedure-related indicators, adverse events, and willingness to repeat preparation are needed. To ensure the effectiveness and safety of the intervention, it is critical to establish a standard, well-structured exercise program for bowel preparation.
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Affiliation(s)
- Yuan-Yuan Zhang
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ramoo Vimala
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ping Lei Chui
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ida Normiha Hilmi
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Lee SE, Oh DJ, Nam JH, Cho H, Kim JH, Lee JK, Lim YJ, Koh MS, Kim SH. Taking Oral Sulfate Tablets with Simethicone for Bowel Preparation Leads to Higher Adenoma Detection Rate than Polyethylene Glycol: A Propensity Score Analysis. Dig Dis Sci 2023; 68:867-876. [PMID: 35781655 DOI: 10.1007/s10620-022-07611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Efficient bowel preparation is essential for preventing colorectal cancer by improving endoscopic adenoma detection. Tablet for bowel preparation containing sulfate salts, OSTs (oral sulfate tablets), has been developed and it is gaining more popularity. However, its efficacy compared to standard preparation agent, PEG-AA (polyethylene glycol), has not been well discovered. We assessed the efficacy of PEG and OSTs using a real-time clinical data warehouse (CDW) model. METHODS We performed a propensity score-matched (PSM) analysis of consecutive adult patients undergoing colonoscopy who received PEG-AA or OSTs prior to colonoscopy at a tertiary academic hospital. The endoscopic records of 992 adult patients were retrospectively analyzed. The clinical data warehouse collected data including bowel preparation, insertion time, observation time, and the detection of polyps and adenomas. Multivariate regression analysis was performed to reveal the factors associated with endoscopic outcomes. RESULTS Among 992 patients included in the study, 770 and 222 patients received PEG-AA and OSTs, respectively. Among the propensity score-matched population (n = 1897), OSTs resulted in better bowel cleansing quality (8.16 vs 7.84, p = 0.014) and a higher adenoma detection rate (38.6% vs 27.1%, p = 0.003). Using PEG-AA, older age, inadequate bowel preparation (BBPS score < 6) and endoscopy by fellows were found to be factors associated with poor adenoma detection. In the elderly over 65 years of age, a significant difference in cleansing quality between the two groups (7.21 vs 8.19, p < 0.001) was found, but its impact on ADR was not prominent (49.5% vs 45.4%, p = 0.653). CONCLUSIONS OSTs with simethicone achieved better endoscopic cleanliness, improving adenoma detection rate compared to the conventional PEG-AA protocol. The synergistic effect of both the convenience of taking tablets and the reduction of intraluminal bubble by adjunctive simethicone improves the clinical efficacy of colonoscopy.
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Affiliation(s)
- Seung Eun Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Dong Jun Oh
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Ji Hyung Nam
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Hyeki Cho
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Jae Hak Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Moon Soo Koh
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Sang Hoon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea.
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Risk factors for inadequate bowel preparation in patients using high- and low-volume cleansing products. Eur J Gastroenterol Hepatol 2023; 35:159-166. [PMID: 36574306 DOI: 10.1097/meg.0000000000002467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Bowel preparation is crucial for colonoscopy completeness and lesions detection. Today, several cleansing products are equally recommended by guidelines, irrespective of patients' characteristics. Identification of preparation-specific risk factors for inadequate bowel preparation may lead to a personalized prescription of cleansing products to refine patients' tolerance and improve endoscopic outcomes. METHODS We prospectively enrolled consecutive outpatients referred for colonoscopy using either a high-volume [HV: 4 l polyethylene glycol (PEG)] or a low-volume (LV: 2 l PEG + bisacodyl) preparation. Day-before regimen or split-dose regimen was used for morning or afternoon colonoscopies, respectively. Univariate and multivariate analyses were conducted to identify risk factors related to inadequate bowel preparation, according to the Boston bowel preparation scale for HV and LV preparations. RESULTS We enrolled 2040 patients, of which 1815 were included in the final analysis (average age 60.6 years, 50.2% men). Half of them (52%) used LV preparation. Adequate preparation was achieved by 87.6% without differences between the HV and LV groups (89.2% vs. 86.6%; P = 0.098). The use of day-before regimen and incomplete assumption of PEG were independent predictors of poor visibility for either HV or LV preparation. However, different specific risk factors for HV [diabetes: odds ratio (OR), 3.81; 95% confidence interval (CI), 1.91-7.58; low level of instruction: OR, 1.95; 95% CI, 1.11-3.44; and previous abdominal surgery: OR, 2.27; 95% CI, 1.20-4.30] and for LV (heart disease: OR, 2.06; 95% CI, 1.09-3.88; age > 65 years: OR, 1.51; 95% CI, 1.01-2.27) preparations were identified. CONCLUSION Day-before preparation and incomplete assumption of the purgative agents affect bowel visibility irrespective of the preparation volume. LV should be preferred to HV preparations in patients with diabetes, low level of instruction, and previous abdominal surgery, whereas an HV preparation should be preferred in patients with heart disease and in older patients.
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Gao Y, Lin XJ, Lin XJ. Effect of Bowel Preparation to Colonoscopy Interval on Preparation Quality and Colonoscopy Outcomes: A Meta-Analysis. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:26-34. [PMID: 36511605 PMCID: PMC9984965 DOI: 10.5152/tjg.2022.22033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study evaluates the effect of bowel preparation to colonoscopy time interval on quality of bowel preparation and outcomes of colonoscopy. METHODS Studies were identified after a literature search in electronic databases and were selected for inclusion based on precise eligibility criteria. Meta-analyses of proportions were performed to achieve overall bowel preparation adequacy and adenoma/polyp detection rates. Odds ratios depicting associations between bowel preparation quality and bowel preparation to colonoscopy time were pooled to achieve an overall estimate. RESULTS Twenty studies (10 341 individuals subjected to colonoscopy) were included. Bowel preparation adequacy rate was higher with shorter (94% [95% CI: 91, 97]) than with longer (84% [95% CI: 79, 89]) interval between bowel preparation and colonoscopy. In a subgroup analysis, <5, 6-10, 11-20, and >20 hours intervals were associated with 94% [95% CI: 92, 97], 92% [95% CI: 86, 96], 85% [95% CI: 77, 91], and 85% [95% CI: 75, 92] adequacy rates, respectively. A pooled analysis of odds ratios also showed that bowel preparations adequacy was significantly better with shorter bowel preparation to colonoscopy time (odds ratio 1.69 [95% CI: 1.23, 2.15]). There was no significant difference in adenoma detection rate between shorter (18% [95% CI: 9, 29]) and longer (19% [95% CI: 15, 22]) bowel preparation to colonoscopy intervals. Polyp detection rate was higher with shorter (47% [95% CI: 27, 68]) than with longer (30% [95% CI: 24, 38]) bowel preparation to colonoscopy interval. CONCLUSION A shorter interval between bowel preparation and colonoscopy led to a higher bowel preparation adequacy rate which was also associated with a higher polyp detection rate.
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Affiliation(s)
| | - Xi-jie Lin
- Corresponding author: Xi-jie Lin, e-mail:
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Tontini GE, Ciprandi G, Vecchi M. Oral Mannitol for Bowel Preparation: A Safe and Effective Reappraisal. Curr Pharm Des 2023; 29:2521-2523. [PMID: 37957862 DOI: 10.2174/0113816128259838231101062452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Gian Eugenio Tontini
- Department of Pathophysiology and Organ Transplantation, Humanitas Clinical and Research Center IRCCS, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Division, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Ciprandi
- Outpatients Departmnent, Casa di Cura Villa Montallegro, Genoa, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Organ Transplantation, Humanitas Clinical and Research Center IRCCS, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Division, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Spada C, Fiori G, Uebel P, Tontini GE, Cesaro P, Grazioli LM, Soru P, Bravi I, Hinkel C, Prada A, Di Paolo D, Zimmermann T, Manes G, Valats JC, Jakobs R, Elli L, Carnovali M, Ciprandi G, Radaelli F, Vecchi M. Oral mannitol for bowel preparation: a dose-finding phase II study. Eur J Clin Pharmacol 2022; 78:1991-2002. [PMID: 36287232 DOI: 10.1007/s00228-022-03405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Background
Successful bowel preparation (BP) for colonoscopy depends on the instructions, diet, the laxative product, and patient adherence, which all affect colonoscopy quality. Nevertheless, there are no laxatives which combine effectiveness, safety, easy self-administration, good patient acceptance, and low cost. However, mannitol, a sugar alcohol, could be an attractive candidate for use in clinical practice if it is shown to demonstrate adequate efficacy and safety.
Aims
The present phase II dose-finding study compared three doses of mannitol (50, 100, and 150 g) to identify the best dose to be used in a subsequent phase III study.
Methods
The Boston Bowel Preparation Scale, caecal intubation rate, adherence, acceptability, and safety profile, including measurement of potentially dangerous colonic gas concentrations (CH4, H2, O2), were considered in all patients. A weighted algorithm was used to identify the best mannitol dose for use in the subsequent study.
Results
The per-protocol population included 60 patients in the 50 g group, 54 in the 100 g group, and 49 in the 150 g group. The 100 g dose was the best as it afforded optimal colon cleansing efficacy (94.4% of patients had adequate BP), adherence, acceptability, and safety, including negligible gas concentrations.
Conclusions
The present study demonstrated that the colon cleansing efficacy and safety of mannitol were dose dependent. Conversely, gas concentrations were not dose dependent and negligible in all patients. Combined evaluation of efficacy, tolerability, and safety, using a weighted algorithm, determined that mannitol 100 g was the best dose for the phase III study.
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Fiori G, Spada C, Soru P, Tontini GE, Bravi I, Cesana BM, Cesaro P, Manes G, Orsatti A, Prada A, Quadarella A, Schettino M, Spina L, Trovato C, Carnovali M, Vecchi M, Cavallaro F, Codazzi M, De Nucci G, De Roberto G, Devani M, Di Paolo D, Elli L, Hinkel C, Jakobs R, Janke D, Lombardo V, Lovera M, Radaelli F, Ravizza D, Uebel P, Valats JC, Vollmar J, Zimmermann T, Ciprandi G. Pharmacokinetics of oral mannitol for bowel preparation for colonoscopy. Clin Transl Sci 2022; 15:2448-2457. [PMID: 37074807 PMCID: PMC9579383 DOI: 10.1111/cts.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/16/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022] Open
Abstract
This study aimed to define the pharmacokinetics (PKs) of oral mannitol used as an osmotic laxative for bowel preparation for colonoscopy. The PKs of oral mannitol was evaluated in a substudy as part of a phase II dose‐finding, international, multicenter, randomized, parallel‐group, endoscopist‐blinded study. Patients were randomly assigned to take 50, 100, or 150 g mannitol. Venous blood samples were drawn at baseline (T0), 1 h (T1), 2 h (T2), 4 h (T4), and 8 h (T8) after completion of mannitol self‐administration. The mean mannitol plasma concentrations (mg/ml) were dose‐dependent with a consistent difference among doses. The mean maximum concentration (Cmax) ± SD was 0.63 ± 0.15, 1.02 ± 0.28, and 1.36 ± 0.39 mg/ml, in the three dosage groups, respectively. The mean area under the curve from zero to infinity (AUC0−∞) was 2.667 ± 0.668, 4.992 ± 1.706, and 7.403 ± 3.472 mg/ml*h in the 50, 100, and 150 g mannitol dose groups, respectively. Bioavailability was similar in the three dose groups and was just over 20% (0.243 ± 0.073, 0.209 ± 0.081, and 0.228 ± 0.093 in the 50, 100, and 150 g mannitol dose groups, respectively). The present study showed that the bioavailability of oral mannitol is just over 20% and is similar for the three tested doses (50, 100, and 150 g). The linear increase in Cmax, AUC0−t8, and AUC0−∞ must be considered when choosing the oral mannitol dose for bowel preparation to avoid its systemic osmotic effects.
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Affiliation(s)
- Giancarla Fiori
- Divisione di Endoscopia, Istituto Europeo di Oncologia IRCCS Milan Italy
| | - Cristiano Spada
- U.O. Endoscopia Digestiva, Fondazione Poliambulanza – Istituto Ospedaliero Brescia Italy
| | - Pietro Soru
- Divisione di Endoscopia, Istituto Europeo di Oncologia IRCCS Milan Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Organ Transplantation University of Milan Milan Italy
- Gastroenterology and Endoscopy Unit IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Ivana Bravi
- Divisione di Endoscopia, Istituto Europeo di Oncologia IRCCS Milan Italy
| | - Bruno Mario Cesana
- Department of Molecular and Transactional Medicine, Statistics and Biomathematics Unit, Faculty of Medicine and Surgery University of Brescia Brescia Italy
| | - Paola Cesaro
- U.O. Endoscopia Digestiva, Fondazione Poliambulanza – Istituto Ospedaliero Brescia Italy
| | - Gianpiero Manes
- U.O.C. Gastroenterologia, ASST Rhodense Presidi di Rho e Garbagnate Garbagnate Milanese (MI) Italy
| | | | - Alberto Prada
- Servizio Gastroenterologia ed Endoscopia Digestiva Istituto Auxologico Italiano Milan Italy
| | - Alessandro Quadarella
- U.O. Endoscopia Digestiva, Fondazione Poliambulanza – Istituto Ospedaliero Brescia Italy
| | - Mario Schettino
- U.O.C. Gastroenterologia, ASST Rhodense Presidi di Rho e Garbagnate Garbagnate Milanese (MI) Italy
| | - Luisa Spina
- Gastroenterology and Endoscopy Unit IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Cristina Trovato
- Divisione di Endoscopia, Istituto Europeo di Oncologia IRCCS Milan Italy
| | | | - Maurizio Vecchi
- Department of Pathophysiology and Organ Transplantation University of Milan Milan Italy
- Gastroenterology and Endoscopy Unit IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico Milan Italy
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Adamek HE, Bergmann L, Müssig K. [Bowel preparation in patients with Diabetes mellitus: Development of a procedure model]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:784-789. [PMID: 35545113 DOI: 10.1055/a-1791-1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adequate bowel preparation prior to colonoscopy is the key factor for high quality preparation for colonoscopy. Inadequate preparation can result in prolonged procedure time, incomplete colonoscopy and an increased risk of procedural adverse events. Diabetes mellitus has been identified as a predictor of inadequate colonoscopy bowel preparation. Currently, standard recommendations for diabetes patients before colonoscopy are missing. METHODS This review is based on a selective literature search in PubMed and Google Scholar carried out in June 2021. Systematic reviews, guidelines, expert opinions, and recommendations from German and international societies were also considered. RESULTS The currently available preparations comprise two different groups: High-, medium- and low- volume polyethylene glycol (PEG) preparations and hyperosmotic agents. So far, a couple of reviews tried to identify outcome related differencies. Results are heterogeneous. In practise, preparation agents and timing of preparation as well as a thorough patient information before the preparation process are considered the most relevant items. In diabetes patients, preinterventional dietary recommendations are of paramount importance. CONCLUSION Split dosing of PEG preparations are recommended in diabetes patients with expected motility disorders. Extensive counseling about preparation intake and dietary recommendations should be offered.
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Affiliation(s)
| | - Laura Bergmann
- Med. Klinik 2, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Karsten Müssig
- Klinik für Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken GmbH, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
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