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Yao-dong L, Yi-ping W, Gang M, Yang-yun H, Ling-ling Z, Hong D, Jia-zheng D, Rong-chao X, You-wei L, Ming Z, Shun-bin D, Jing L, Yang S, Jia-qi D, Lei D, Xiong-feng S, You-jian Z, Zuo-qiong Z. Comparison of oral sodium phosphate tablets and polyethylene glycol lavage solution for colonoscopy preparation: a systematic review and meta-analysis of randomized clinical trials. Front Med (Lausanne) 2023; 10:1088630. [PMID: 37305114 PMCID: PMC10250678 DOI: 10.3389/fmed.2023.1088630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Objective To systematically compare the bowel cleaning ability, patient tolerance and safety of oral sodium phosphate tablets (NaPTab) and oral polyethylene glycol electrolyte lavage solution (PEGL) to inform clinical decision making. Methods PubMed, Embase, CBM, WanFang Data, CNKI, and VIP databases were searched for studies that used randomized controlled trials (RCTs) to compare the roles of NaPTab and PEGL in bowel preparation before colonoscopy. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias in the included papers. A meta-analysis was performed using RevMan 5.3 software. Results A total of 13 RCTs were eligible for inclusion, including 2,773 patients (1,378 and 1,395 cases in the NaPTab and PEGL groups, respectively). Meta-analysis revealed no significant difference in the cleansing quality of the NaPTab and PEGL groups [RR 1.02, 95% CI (0.96-1.08), P = 0.46]. The incidence of nausea was lower in the NaPTab group than in the PEGL group [RR 0.67, 95% CI (0.58-0.76), p < 0.00001]. Patients rated the taste of NaPTab higher than PEGL [RR 1.33, 95% CI (1.26-1.40), P < 0.00001]. Willingness to repeat the treatment was also higher in the NaPTab group than in the PEGL group [RR 1.52, 95% CI (1.28-1.80), P < 0.00001]. Both serum potassium and serum calcium decreased in both groups after the preparation; however, meta-analysis revealed that both minerals decreased more in the NaPTab group than in the PEGL group [MD = 0.38, 95% CI (0.13-0.62), P = 0.006 for serum potassium and MD = 0.41, 95% CI (0.04-0.77), P = 0.03 for serum calcium]. Meanwhile, serum phosphorus increased in both groups after the preparation; however, levels increased more in the NaPTab group than in the PEGL group [MD 4.51, (95% CI 2.9-6.11), P < 0.00001]. Conclusions While NaP tablets and PEGL were shown to have a similar cleaning effect before colonoscopy, NaP tablets had improved patient tolerance. However, NaP tablets had a strong effect on serum potassium, calcium, and phosphorus levels. For patients with low potassium, low calcium, and renal insufficiency, NaP tablets should be prescribed with caution. For those at high-risk for acute phosphate nephropathy, NaP tablets should be avoided. Given the low number and quality of included studies, these conclusions will require additional verification by large high-quality studies. Systematic review registration 10.37766/inplasy2023.5.0013, identifier: NPLASY202350013.
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Affiliation(s)
- Li Yao-dong
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wang Yi-ping
- West China Hospital, Sichuan University, Chengdu, China
| | - Mai Gang
- Surgical Department of Deyang People's Hospital, Deyang, China
| | - Han Yang-yun
- Surgical Department of Deyang People's Hospital, Deyang, China
| | - Zhu Ling-ling
- West China Hospital, Sichuan University, Chengdu, China
| | - Deng Hong
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Deng Jia-zheng
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Xiang Rong-chao
- Surgical Department of Deyang People's Hospital, Deyang, China
| | - Li You-wei
- Surgical Department of Deyang People's Hospital, Deyang, China
| | - Zhao Ming
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Ding Shun-bin
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Ling Jing
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Shen Yang
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Dong Jia-qi
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Deng Lei
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Song Xiong-feng
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Zhang You-jian
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Zhou Zuo-qiong
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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2
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Zhao X, Wang L, Quan L. Association between dietary phosphorus intake and chronic constipation in adults: evidence from the National Health and Nutrition Examination Survey. BMC Gastroenterol 2023; 23:24. [PMID: 36694113 PMCID: PMC9875444 DOI: 10.1186/s12876-022-02629-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Several studies suggest a link between micronutrients and constipation. However, the relationship between constipation and phosphorus has rarely been examined. The main aim of this study was to investigate the association between changes in the prevalence of chronic constipation and dietary phosphorus intake among adult respondents of the National Health and Nutritional Examination Survey (NHANES). METHODS Data were extracted from the NHANES database for the years 2005-2010. A total of 13,948 people were included in the analysis. Dietary information was collected using the respondents' 24-h dietary records. We conducted multiple logistic regression analyses to examine the correlation between phosphorus intake and poor bowel movement. The primary and secondary outcomes was constipation defined by stool consistency and stool frequency, respectively. RESULTS Following multi-variate adjustment in model III, a significant association between chronic constipation and each additional 0.1-g intake of dietary phosphorus (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95, 1.00; P = 0.034 for stool consistency vs. OR, 0.94; 95% CI, 0.90, 0.99; P = 0.027 for stool frequency) was observed. Following multi-variate adjustment in model III, OR values and 95% CI from the second to fourth quartiles compared to the first quartile (reference group) were 0.92 (0.66, 1.27), 0.73 (0.47, 1.13), and 0.39 (0.20, 0.76), respectively, using the stool frequency definition. CONCLUSIONS This study revealed a negative correlation between phosphorus intake and chronic constipation. This may be due to the fact that dietary phosphorus intake is associated with softer stools and increased stool frequency. Further studies in different settings should be considered to verify these findings.
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Affiliation(s)
- Xuelian Zhao
- grid.464402.00000 0000 9459 9325The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250013 Shandong Province People’s Republic of China
| | - Lizhu Wang
- grid.479672.9Department of Anorectal, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014 Shandong Province People’s Republic of China
| | - Longfang Quan
- grid.410318.f0000 0004 0632 3409Department of Anorectal, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, 100091 People’s Republic of China
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3
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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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4
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Maratt JK, Siegel CA, Barkun AN, Bouhnik Y, Bressler B, Calderwood AH, East JE, Fischer M, Grossmann J, Korzenik JR, Menees SB, Panes J, Rex DK, Sey MSL, Allio MK, Baker KA, Guizzetti L, Remillard J, Sedano R, Feagan BG, Ma C, Jairath V. An Expert Consensus to Standardize Assessment of Bowel Cleansing for Clinical Trials of Bowel Preparations for Crohn's Disease. Dig Dis Sci 2022; 68:1718-1727. [PMID: 36436154 DOI: 10.1007/s10620-022-07775-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite regular need for colonoscopy in patients with Crohn's disease (CD), the efficacy and tolerability of bowel preparation (BP) agents is rarely assessed in this population. Assessing BP quality with existing scales may be challenging in CD due to presence of inflammation, bowel resection, and strictures. AIMS To provide recommendations for assessing BP quality in clinical trials for CD using a modified Research and Development/University of California, Los Angeles appropriateness process. METHODS Based on systematic reviews and a literature search, 110 statements relating to BP quality assessment in CD were developed. A panel of 15 gastroenterologists rated the statements as appropriate, uncertain, or inappropriate using a 9-point Likert scale. RESULTS Panelists considered it appropriate that central readers, either alone or with local assessment, score BP quality in clinical trials. Central readers should be trained on scoring BP quality and local endoscopists on performing high-quality video recording. Both endoscope insertion and withdrawal phases should be reviewed to score BP quality in each colonic segment and segments should align with endoscopic disease activity indices. The Harefield Cleansing Scale and the Boston Bowel Preparation Scale were considered appropriate. The final score should be calculated as the average of all visualized segments. Both total and worst segment scores should also be assessed. CONCLUSIONS We developed a framework for assessing BP quality in patients with CD based on expert feedback. This framework could support the development or refinement of BP quality scales and the integration of BP quality assessment in future CD studies.
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Affiliation(s)
- Jennifer K Maratt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10Th St, Indianapolis, IN, 46202, USA.,Richard L. Roudebush Veterans Affairs Medical Center, 1481 W 10Th St, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Inc, 1101 W 10Th St, Indianapolis, IN, 46202, USA
| | - Corey A Siegel
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03766, USA
| | - Alan N Barkun
- Division of Gastroenterology, McGill University and McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Yoram Bouhnik
- Gastroenterology and Nutrition Support Department, Department of Gastroenterology, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Brian Bressler
- Division of Gastroenterology, Department of Medicine, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Audrey H Calderwood
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03766, USA.,The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH, 03755, USA.,Dartmouth Institute of Health Policy and Clinical Practice, 1 Medical Center Dr, Lebanon, NH, 03766, USA
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.,Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare London, 15 Portland Pl, London, W1B 1PT, UK
| | - Monika Fischer
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10Th St, Indianapolis, IN, 46202, USA
| | - Johannes Grossmann
- Department of Internal Medicine I, Bethesda Hospital, Glindersweg 80, 21029, Hamburg, Germany.,Johanniter GmbH, Ludwig-Weber-Straße 15, 41061, Mönchengladbach, Germany
| | - Joshua R Korzenik
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Stacy B Menees
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA.,Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA
| | - Julian Panes
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigaciones Biomédicas en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10Th St, Indianapolis, IN, 46202, USA
| | - Michael S L Sey
- Division of Gastroenterology, Department of Medicine, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Michael K Allio
- ColonaryConcepts LLC, 103 San Marco Dr, Palm Beach Gardens, FL, 33418, USA
| | - K Adam Baker
- Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada
| | | | - Julie Remillard
- Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada
| | - Rocio Sedano
- Division of Gastroenterology, Department of Medicine, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada
| | - Brian G Feagan
- Division of Gastroenterology, Department of Medicine, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada.,Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Christopher Ma
- Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada.,Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada. .,Alimentiv Inc, 100 Dundas St Suite 200, London, ON, N6A 5B6, Canada. .,Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada. .,Department of Medicine, Western University, 399 Windermere Road, London, ON, N6A 5A5, Canada.
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Potential Factors Predicting Histopathologically Upgrade Discrepancies between Endoscopic Forceps Biopsy of the Colorectal Low-Grade Intraepithelial Neoplasia and Endoscopic Resection Specimens. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1915458. [PMID: PMID: 35707387 PMCID: PMC9192244 DOI: 10.1155/2022/1915458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/21/2022] [Indexed: 12/24/2022]
Abstract
Background It was gradually accepted that endoscopic fragment biopsy (EFB) diagnosis cannot accurately guarantee the absence of higher-grade neoplasms within the lesion of the digestive tract. There are no well-established predictors for histopathologically upgrade discrepancies between EFB diagnosing colorectal low-grade intraepithelial neoplasia (LGIN) and endoscopic resection (ER) specimens. Methods A total of 918 colorectal LGINs was histopathologically diagnosed by EFB, including 162 cases with upgrade discrepancy and 756 concordant cases. We compared clinicopathological data of EFB and ER specimens between these two groups. Multivariate analysis was performed to identify predictors for this upgrade histopathology. Results The predominant upgrade discrepancy of LGINs diagnosed by EFB was upgrades to high-grade dysplasia (114/918, 12.4%), followed by upgrades to intramucosal carcinoma (33/918, 3.6%), submucosal adenocarcinoma (10/918, 1.1%), and advanced adenocarcinoma (5/918, 0.5%). NSAID history (OR 4.83; 95% CI, 2.27-10.27; p < 0.001), insufficient EFB number (OR 2.99; 95% CI, 1.91-4.68; p < 0.001), maximum diameter ≥ 1.0 cm (OR 6.18; 95% CI, 1.32-28.99; p = 0.021), lobulated shape (OR 2.68; 95% CI, 1.65-4.36; p < 0.001), erythema (OR 2.42; 95% CI, 1.50-3.91; p < 0.001), erosion (OR 7.12; 95% CI, 3.91-12.94; p < 0.001), surface unevenness (OR 2.31; 95% CI, 1.33-4.01; p = 0.003), and distal location of the target adenoma (OR 3.29; 95% CI, 1.68-6.41; p < 0.001) were associated with the histologically upgrade discrepancies. Conclusion NSAID history, insufficient EFB number, adenoma size and location, and abnormal macroscopic patterns are potential predictors for upgrade histopathology of LGINs diagnosed by EFBs. The standardization of EFB number and advanced imaging techniques could minimize the risk of neglecting the potential of this upgrade histopathology.
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6
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Tontini GE, Prada A, Sferrazza S, Ciprandi G, Vecchi M. The unmet needs for identifying the ideal bowel preparation. JGH OPEN 2021; 5:1135-1141. [PMID: 34621998 PMCID: PMC8485412 DOI: 10.1002/jgh3.12653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/21/2021] [Indexed: 12/23/2022]
Abstract
Colonoscopy, since it was first employed over 60 years ago, is now the gold standard method for visualizing the mucosa of the colon, but should be of good quality. Many factors affect quality, including the type of health service organization, type of facility, staff, equipment, patient characteristics, and bowel preparation (BP). The adequacy of bowel cleansing is critical, but, unfortunately, may be inadequate in up to one‐third of procedures. The current article will present and discuss the main BPs and their drawbacks, which include patient‐dependent and procedure‐dependent factors. Cleansing quality depends on the ease/complexity of solution preparation, volume, taste, and timing of consumption. Consequently, important positive factors include simple instructions, easy preparation of the solution, low volume, pleasant taste, short drinking time (e.g. <30 min), and splitting the dose between the evening before and the morning of the colonoscopy (or even better, only one dose in the early morning to avoid night‐time problems), and short onset of action. The BP solution must also be safe with negligible side effects. Furthermore, a positive experience supports patient willingness to repeat the procedure.
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Affiliation(s)
- Gian E Tontini
- Department of Internal Medicine Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Alberto Prada
- Digestive Endoscopy Istituto Auxologico Italiano Milan Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Area Chirurgia Specialistica Santa Chiara Hospital Trento Italy
| | - Giorgio Ciprandi
- Outpatient Department, Casa di Cura Villa Montallegro Genoa Italy
| | - Maurizio Vecchi
- Department of Internal Medicine Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
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7
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Gastrointestinal endoscopy in children and adults: How do they differ? Dig Liver Dis 2021; 53:697-705. [PMID: 33692010 DOI: 10.1016/j.dld.2021.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
Gastrointestinal endoscopy has grown dramatically over the past century, and with subsequent improvements in technology and anaesthesia, it has become a safe and useful tool for evaluation of GI pathology in children. There are substantial differences between paediatric and adult endoscopy beyond size, including: age-related patho-physiology and the different spectrum of diseases in children. Literature on endoscopic procedures in children is sparse but significant. The present review aims at describing the current knowledges on paediatric endoscopy practice and highlights the main areas of differences between paediatric and adult practice.
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8
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Hung SY, Chen HC, Ke TW, Chen JH, Hsiao KH, Wang HM, Chiang HC, Chang SC, Chen YC, Hsieh MH, Tsai YY, Hsieh YW, Chen WTL. Noninferiority clinical trial comparing the bowel cleansing efficacy of sodium phosphate tablets (Quiklean ®) with a polyethylene glycol/bisacodyl kit. World J Gastroenterol 2021; 27:428-441. [PMID: 33584074 PMCID: PMC7856840 DOI: 10.3748/wjg.v27.i5.428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Efficient bowel cleansing is essential for a successful colonoscopy, but the ideal cleansing agent, volume, and pharmaceutical dosage form have yet to be determined. Small-volume cleansers enhance patient compliance.
AIM To compare the bowel cleansing efficacy of 32-tablet sodium phosphate (Quiklean®) with 2-L polyethylene glycol (PEG)/bisacodyl (Klean-Prep/ Dulcolax®) under identical dietary recommendations.
METHODS This multicenter, randomized, parallel-group, noninferiority clinical trial enrolled 472 outpatients, randomized 456 subjects, and scheduled 442 subjects to undergo colonoscopy (Quiklean® = 222 and Klean-Prep/Dulcolax® = 220). After bowel preparation, a colonoscopist performed the colonoscopy with video recorded for rating. The primary efficacy endpoint was the bowel cleansing quality using the Aronchick Scale. The secondary endpoints were the bowel cleansing efficacy of three colon segments, tolerability and acceptability, safety using the Ottawa bowel preparation scale, questionnaires by subjects, and monitoring of adverse events.
RESULTS Success rates (Excellent + Good) of the bowel cleansing quality by Aronchick Scale were 98.6% (n = 205) and 97.6% (n = 204) in the Quiklean® and Klean-Prep/Dulcolax® groups, respectively. Quiklean® demonstrated noninferiority over Klean-Prep/Dulcolax® in colon cleansing efficacy. Quicken showed better tolerability and acceptability in the overall experience (was rated as excellent; 24.0% vs 17.2%; P = 0.0016) and the taste of the study preparation (was rated as excellent, 23.1% vs 13.4%; P < 0.0001) than Klean-Prep/Dulcolax®. Safety profiles did not differ between the two groups. Our data indicate that Quiklean® is an adequate, well-tolerated bowel cleansing preparation compared with the standard comparator Klean-Prep/Dulcolax®.
CONCLUSION Quiklean® is sodium phosphate tablets available on Taiwan’s market for bowel preparation; it potentially offers patients an alternative to standard large-volume bowel preparation regimens and may, therefore, increase positive attitudes toward colonoscopies and participation rates.
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Affiliation(s)
- Shih-Ya Hung
- Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
| | - Hung-Chang Chen
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Tao-Wei Ke
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Jiann-Hwa Chen
- Division of Gastroenterology, Taipei Tzu Chi Hospital, Taipei 23142, Taiwan
| | - Koung-Hung Hsiao
- Division of Colorectal Surgery, Taipei Tzu Chi Hospital, Taipei 23142, Taiwan
| | - Hwei-Ming Wang
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Hua-Che Chiang
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Sheng-Chi Chang
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Yi-Chang Chen
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Ming-Hao Hsieh
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Yuan-Yao Tsai
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Yo-Wen Hsieh
- Department of Pharmacy, China Medical University Hospital, Taichung 40447, Taiwan
| | - William Tzu-Liang Chen
- Department of Colorectal Surgery, China Medical University Hsinchu Hospital, Zhubei 30272, Taiwan
- School of Medicine, China Medical University, Taichung 40402, Taiwan
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Abstract
Colorectal cancer (CRC) is a common and preventable malignancy, and routine CRC screening is recommended for average risk individuals between the ages of 50 and 75 years. Screening has been shown to decrease CRC incidence and mortality. Once patients are older than 75 years, the risk to benefit ratio of ongoing screening begins to shift. As comorbidities increase and life expectancy decreases, the future potential benefits of CRC prevention become less robust, and risk for screening-related complications grows. However, firm age cutoffs are not sufficient to guide these decisions, as there is substantial physiologic heterogeneity among individuals of the same age.
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Affiliation(s)
- Andrea L Betesh
- Department of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY 10021, USA.
| | - Felice H Schnoll-Sussman
- Department of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, 1315 York Avenue, Ground Floor, New York, NY 10021, USA
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10
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Hernandez PV, Horsley-Silva JL, Snyder DL, Baffy N, Atia M, Koepke L, Buras MR, Lim ES, Ruff K, Umar SB, Islam S, Ramirez FC. Effect of bowel preparation volume in inpatient colonoscopy. Results of a prospective, randomized, comparative pilot study. BMC Gastroenterol 2020; 20:227. [PMID: 32660521 PMCID: PMC7359276 DOI: 10.1186/s12876-020-01373-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background Inpatient status has been shown to be a predictor of poor bowel preparation for colonoscopy; however, the optimal bowel preparation regimen for hospitalized patients is unknown. Our aim was to compare the efficacy of bowel preparation volume size in hospitalized patients undergoing inpatient colonoscopy. Methods This prospective, single blinded (endoscopist), randomized controlled trial was conducted as a pilot study at a tertiary referral medical center. Hospitalized patients undergoing inpatient colonoscopy were assigned randomly to receive a high, medium, or low-volume preparation. Data collection included colon preparation quality, based on the Boston Bowel Preparation Scale, and a questionnaire given to all subjects evaluating the ability to completely finish bowel preparation and adverse effects (unpleasant taste, nausea, and vomiting). Results Twenty-five colonoscopies were performed in 25 subjects. Patients who received low-volume preparation averaged a higher mean total BBPS (7.4, SD 1.62), in comparison to patients who received high-volume (7.0, SD 1.41) and medium-volume prep (6.9, SD 1.55), P = 0.77. When evaluating taste a higher score meant worse taste. The low-volume group scored unpleasant taste as 0.6 (0.74), while the high-volume group gave unpleasant taste a score of 2.2 (0.97) and the medium-volume group gave a score of 2.1 (1.36), P < 0.01. Conclusion In this pilot study we found that low-volume colon preparation may be preferred in the inpatient setting due its better rate of tolerability and comparable bowel cleanliness when compared to larger volume preparation, although we cannot overreach any definitive conclusion. Further more robust studies are required to confirm these findings. Trial registration The Affect of Low-Volume Bowel Preparation for Hospitalized Patients Colonoscopies. Trial registration: NCT01978509 (terminated). Retrospectively registered on November 07, 2013.
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Affiliation(s)
- Patricia V Hernandez
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jennifer L Horsley-Silva
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Diana L Snyder
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Noemi Baffy
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Mary Atia
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Laura Koepke
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Matthew R Buras
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic Arizona, Scottsdale, USA
| | - Elisabeth S Lim
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic Arizona, Scottsdale, USA
| | - Kevin Ruff
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Sarah B Umar
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Sameer Islam
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Francisco C Ramirez
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
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Sharma P, Burke CA, Johnson DA, Cash BD. The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention. Endosc Int Open 2020; 8:E673-E683. [PMID: 32355887 PMCID: PMC7165013 DOI: 10.1055/a-1127-3144] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Colonoscopy for colorectal cancer (CRC) screening has reduced CRC incidence and mortality and improved prognosis. Optimal bowel preparation and high-quality endoscopic technique facilitate early CRC detection. This review provides a narrative on the clinical importance of bowel preparation for colonoscopy and highlights available bowel preparations. Methods A PubMed search was conducted through June 2019 to identify studies evaluating clinical outcomes, efficacy, safety, and tolerability associated with bowel preparation for CRC screening-related colonoscopy. Results Selecting the optimal bowel preparation regimen is based on considerations of efficacy, safety, and tolerability, in conjunction with individual patient characteristics and preferences. Available bowel preparations include high-volume (4 L) and low-volume (2 L and 1 L), polyethylene glycol (PEG) solutions, sodium sulfate, sodium picosulfate/magnesium oxide plus anhydrous citric acid, sodium phosphate tablets, and the over-the-counter preparations magnesium citrate and PEG-3350. These preparations may be administered as a single dose on the same day or evening before, or as two doses administered the same day or evening before/morning of colonoscopy. Ingesting at least half the bowel preparation on the day of colonoscopy (split-dosing) is associated with higher adequate bowel preparation quality versus evening-before dosing (odds ratio [OR], 2.5; 95 % confidence interval [CI], 1.9-3.4). Conclusions High-quality bowel preparation is integral for optimal CRC screening/surveillance by colonoscopy. Over the last 30 years, patients and providers have gained more options for bowel preparation, including low-volume agents with enhanced tolerability and cleansing quality that are equivalent to 4 L preparations. Split-dosing is preferred for achieving a high-quality preparation.
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Affiliation(s)
- Prateek Sharma
- University of Kansas Medical Center, Kansas City, Kansas, United States
| | | | - David A. Johnson
- Eastern Virginia Medical School, Norfolk, Virginia, United States
| | - Brooks D. Cash
- University of Texas Health Science Center, Houston, Texas, United States
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12
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Dang JT, Moolla M, Dang TT, Shaw A, Tian C, Karmali S, Sultanian R. Sodium phosphate is superior to polyethylene glycol in constipated patients undergoing colonoscopy: a systematic review and meta-analysis. Surg Endosc 2020; 35:900-909. [PMID: 32124060 DOI: 10.1007/s00464-020-07464-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Constipation is an important and highly prevalent predictor of inadequate bowel preparation during colonoscopy. In North America, between 2 and 28% of the general population suffer from constipation. Despite the high prevalence of constipation, to our knowledge, no meta-analysis on the optimal bowel preparation for constipated patients has been performed. We aimed to systematically review the literature to determine the ideal bowel preparation regiment for patients with chronic constipation. METHODS A comprehensive search of electronic databases (MEDLINE, EMBASE, SCOPUS, and Web of Science) was performed. We included studies that assessed the quality of bowel preparation in constipated patients receiving different agents prior to colonoscopy. The primary outcome was colon cleanliness. Secondary outcomes included tolerability of the bowel preparation and serious adverse events. RESULTS Preliminary database search yielded 1581 articles after duplicates were removed. After screening of the titles and abstracts using the exclusion criteria, 358 full-text articles were retained. Full-text articles were reviewed and eight studies meeting the inclusion criteria were included for qualitative synthesis. Three randomized controlled trials identified a total of 1636 constipated patients, of whom 225 were eligible for meta-analysis. Of those, 107 (47.6%) received NaP and 118 (52.4%) received PEG. Patients receiving NaP before colonoscopy had a higher chance of a successful bowel preparation than patients receiving PEG (OR 1.87, CI 1.06 to 3.32, P = 0.003). In the studies comparing PEG to NaP, two found that NaP resulted in greater tolerability of the bowel preparation and one study found that PEG resulted in superior tolerability. CONCLUSIONS In chronically constipated patients undergoing colonoscopy, the use of NaP may result in superior colonic cleanliness when compared to PEG, however, quality of evidence was low. Further high-quality studies are required to delineate the optimal bowel preparation in patients with constipation.
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Affiliation(s)
- Jerry T Dang
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
- Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
| | - Muhammad Moolla
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - ThucNhi Tran Dang
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Ashley Shaw
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Chunhong Tian
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Richard Sultanian
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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13
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Yi LJ, Tian X, Shi B, Chen H, Liu XL, Pi YP, Chen WQ. Low-Volume Polyethylene Glycol Improved Patient Attendance in Bowel Preparation Before Colonoscopy: A Meta-Analysis With Trial Sequential Analysis. Front Med (Lausanne) 2019; 6:92. [PMID: 31134201 PMCID: PMC6512395 DOI: 10.3389/fmed.2019.00092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 04/16/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Polyethylene glycol (PEG) has been regarded as the primary recommendation for bowel preparation before colonoscopy. However, a conclusive conclusion has not yet been generated. Aim: We performed this updated meta-analysis to further investigate the comparative efficacy and safety of low volume preparation based on PEG plus ascorbic acid related to 4L PEG. Methods: A systematic search was conducted to retrieve potential randomized controlled trials (RCTs) in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 2000 to April 2018. Two independent searchers critically searched all potential citations, extracted data, and appraised risk of bias accordingly. Moreover, we used the STATA 12.0 and trial sequential analysis (TSA) 0.9 to complete all analyses. Results: A total of 13 RCTs enrolling 3,910 patients met inclusion criteria. Meta-analysis based on PP analysis indicated that compared to standard volume PEG regime, low volume regime improved patient compliance RR = 1.01; 95% CIs = 1.00, 1.03; P = 0.143 (≥75% intake); RR = 1.07; 95% CIs = 1.00, 1.14; P = 0.046 (100% intake), the willingness to repeat the same regime (RR = 1.30; 95% CIs = 1.07, 157; P = 0.007), and patient acceptability (RR = 1.18; 95% CIs = 1.07, 1.29; P = 0.001), and decreased the overall adverse events (RR = 0.86; 95% CIs = 0.77, 0.96; P = 0.009). However, no difference was observed between these two different solutions for bowel preparation efficacy (RR = 0.98; 95% CIs = 0.95, 1.02; P = 0.340). These all results were further confirmed by TSA. Conclusions: The effect of low volume regime was not inferior to the standard volume PEG regime, and low volume regime was associated with better compliance when subjects ingested all the solution, willingness to repeat the same regime, higher acceptability, and lower nausea in non-selected population.
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Affiliation(s)
- Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Xu Tian
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Bing Shi
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Hui Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Xiao-Ling Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Yuan-Ping Pi
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
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14
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Spinzi G, Andrealli A, Conforti FS. Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy. Gastrointest Endosc 2018; 88:575. [PMID: 30115313 DOI: 10.1016/j.gie.2018.04.2348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 02/08/2023]
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15
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Yi LJ, Tian X, Pi YP, Feng L, Chen H, Liu XL, Chen WQ. Comparative efficacy of low volume versus traditional standard volume PEG on bowel preparation before colonoscopy: Protocol for an updated meta-analysis with trial sequential analysis. Medicine (Baltimore) 2018; 97:e0599. [PMID: 29703060 PMCID: PMC5944532 DOI: 10.1097/md.0000000000010599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Polyethylene glycol (PEG) has been considered as the first recommendation for bowel preparation prior to colonoscopy. A previous meta-analysis suggested that low volume PEG may improve the acceptability of ingesting bowel preparation solution. However, several limitations impaired the power of findings from this published meta-analysis, such as the variation in study design of included trials and adjuvant prescriptions. Moreover, some studies related to this topic have been published recently. And thus, the aim of this updated meta-analysis is to further assess the comparative efficacy of low volume versus standard volume of PEG on bowel preparation before colonoscopy with trial sequential analysis (TSA). METHODS AND ANALYSIS Systematic searches will be performed to capture any potential randomized controlled trials (RCTs) investigated the comparative efficacy of low volume versus traditional standard volume PEG on bowel preparation prior to colonoscopy in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Moreover, we will also manually check the bibliographies of related studies and reviews so as to get additional studies. Two reviewers will independently screen the citation records, extract essential information, and appraise the risk of bias of each RCT in sequence. Finally, we will used the STATA software version 12.0 and TSA software version beta 0.9 to statistically analyze all data and test the robust of each pooled result, respectively. RESULTS We will submit the full-text of systematic review to a peer-review journal for publication. CONCLUSION This updated systematic review and meta-analysis with TSA will further assess the comparative efficacy and safety of low-volume versus traditional standard volume PEG for bowel preparation prior to colonoscopy. And then, a more comprehensive evidence body on low-volume compared to standard volume PEG in bowel preparation will be constructed.
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Affiliation(s)
- Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou
| | - Xu Tian
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
- Editorial Office, TMR Integrative Nursing, TMR Publishing Group, Tianjin
| | - Yuan-Ping Pi
- Department of Nursing, Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
| | - Ling Feng
- Department of Foundation Medicine, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Hui Chen
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
| | - Xiao-Ling Liu
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
| | - Wei-Qing Chen
- Department of Gastroenterology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing
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16
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Gross SA, Gerson LB, Lewis BS, Ganz RA. A novel device for improving visualization in an inadequately prepared colon. Gastrointest Endosc 2018; 87:883-888. [PMID: 29108983 DOI: 10.1016/j.gie.2017.10.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 10/13/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Adequate bowel preparation is crucial for a quality colonoscopy. Poor bowel preparation can result in longer procedural times, missed adenomas, earlier repeat procedures, increase costs, and decreased patient satisfaction. Pure-Vu (MOTUS GI, Tirat Carmel, Israel) is a system that facilitates intraprocedural cleaning of a poorly prepared colon during a colonoscopy by irrigating the colon and evacuating the fluid and feces. The study aims were to evaluate Pure-Vu's cleansing capabilities and its usability and safety in a live animal colon. METHODS The Pure-Vu system was used by 4 experienced gastroenterologists in 35 Yorkshire cross swine (66% female) that received a reduced bowel preparation to ensure an inadequate bowel preparation at baseline. Before colonoscopy the Pure-Vu was attached to the colonoscope, and the baseline prep was assessed during insertion. The Pure-Vu system was then used to cleanse the colon and the prep then assessed after Pure-Vu use. RESULTS No adverse effects and no failed or prematurely terminated cases were noted. Fourteen percent of the swine colons were adequately prepped at baseline (median Boston Bowel Preparation Scale [BBPS] score = 0 [25th percentile = 0; 75th percentile = 1; interquartile range = 1]) and improved to 100% after use of Pure-Vu (Wilcoxon signed rank test P < .001) (median BBPS score = 3 [25th percentile = 3; 75th percentile = 3; interquartile range = 0]). The physicians found Pure-Vu easy and intuitive to operate. CONCLUSIONS The Pure-Vu system effectively cleaned inadequately prepped swine colons and proved to be easy to use. The Pure-Vu device, applied in clinical practice, may result in improved overall prep quality and a reduction in repeat examinations because of inadequately prepped colons.
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Affiliation(s)
- Seth A Gross
- Tisch Hospital, NYU Langone Medical Center, New York, New York, USA
| | - Lauren B Gerson
- California Pacific Medical Center, San Francisco, California, USA
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17
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Aygün C. Improving the quality of colonoscopy: Impact of efficient and safer preparation protocols and shorter waiting times. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:4-6. [PMID: 29391302 DOI: 10.5152/tjg.2018.18003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Cem Aygün
- Division of Gastroenterology, Department of Internal Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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18
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Jun JH, Han KH, Park JK, Seo HI, Kim YD, Lee SJ, Jun BG, Hwang MS, Park YK, Kim MJ, Cheon GJ. Randomized clinical trial comparing fixed-time split dosing and split dosing of oral Picosulfate regimen for bowel preparation. World J Gastroenterol 2017; 23:5986-5993. [PMID: 28932091 PMCID: PMC5583584 DOI: 10.3748/wjg.v23.i32.5986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/10/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the efficacy of fixed-time split dose and split dose of an oral sodium picosulfate for bowel preparation.
METHODS This is study was prospective, randomized controlled study performed at a single Institution (2013-058). A total of 204 subjects were assigned to receive one of two sodium picosulfate regimens (i.e., fixed-time split or split) prior to colonoscopy. Main outcome measurements were bowel preparation quality and subject tolerability.
RESULTS There was no statistical difference between the fixed-time split dose regimen group and the split dose regimen group (Ottawa score mean 2.57 ± 1.91 vs 2.80 ± 2.51, P = 0.457). Cecal intubation time and physician’s satisfaction of inspection were not significantly different between the two groups (P = 0.428, P = 0.489). On subgroup analysis, for afternoon procedures, the fixed-time split dose regimen was equally effective as compared with the split dose regimen (Ottawa score mean 2.56 ± 1.78 vs 2.59 ± 2.27, P = 0.932). There was no difference in tolerability or compliance between the two groups. Nausea was 21.2% in the fixed-time split dose group and 14.3% in the split dose group (P = 0.136). Vomiting was 7.1% and 2.9% (P = 0.164), abdominal discomfort 7.1% and 4.8% (P = 0.484), dizziness 1% and 4.8% (P = 0.113), cold sweating 1% and 0% (P = 0.302) and palpitation 0% and 1% (P = 0.330), respectively. Sleep disturbance was two (2%) patients in the fixed-time split dose group and zero (0%) patient in the split dose preparation (P = 0.143) group.
CONCLUSION A fixed-time split dose regimen with sodium picosulfate is not inferior to a split dose regimen for bowel preparation and equally effective for afternoon colonoscopy.
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Affiliation(s)
- Jae Hyuck Jun
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
| | - Koon Hee Han
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
| | - Jong Kyu Park
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
| | - Hyun Il Seo
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
| | - Young Don Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
| | - Sang Jin Lee
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
| | - Baek Gyu Jun
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
| | - Min Sik Hwang
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
| | - Yoon Kyoo Park
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
| | | | - Gab Jin Cheon
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, South Korea
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Comparison of Two Intensive Bowel Cleansing Regimens in Patients With Previous Poor Bowel Preparation: A Randomized Controlled Study. Am J Gastroenterol 2017; 112:951-958. [PMID: 28291237 DOI: 10.1038/ajg.2017.53] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 01/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Inadequate bowel cleansing is a major burden for endoscopy units. The aim of this study was to compare two intensive bowel cleansing regimens in patients with previous colonoscopy with inadequate bowel preparation. METHODS Patients with inadequate cleansing at index colonoscopy were randomized to 4-L split-dose polyethylene-glycol (PEG) regimen vs. 2-L split-dose PEG plus ascorbic acid (PEG+Asc) regimen. All individuals underwent a 3-day low-residue diet and received 10 mg of bisacodyl, the day before colonoscopy. Cleansing was considered to be adequate if the Boston Bowel Preparation Scale scored ≥2 at each colonic segment. A non-inferiority analysis was performed to demonstrate that colonic cleansing with 2-L PEG+Asc was not inferior to 4-l PEG, considering a non-inferiority margin of 10%. RESULTS Adequate bowel cleansing was significantly higher in patients assigned to 4-L PEG regimen (n=127) vs. those randomized to 2-L PEG+Asc regimen (n=129) by intention-to-treat analysis (81.1 vs. 67.4%, odds ratio (OR) 2.07, 95% confidence interval (CI) (1.163-3.689)) and by per-protocol analysis (86.6 vs. 71.7%, OR: 2.55, 95% CI: (1.316-4.922)). The study was terminated for futility after the interim analysis, because the 95% CI of the difference of proportions was 3.13-24.27% in the intention-to-treat analysis and 3.33-26.47% in the per-protocol analysis, confirming the superiority of 4-L PEG preparation. CONCLUSIONS After 3-day low-residue diet and oral bisacodyl before colonoscopy, colon cleansing with 4-L split-dose PEG was superior to 2-L split-dose PEG+Asc in patients with previous inadequate cleansing. (EUDRACT: 2013-002506-31, NCT02073552).
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Comparative Evaluation of the Efficacy of Polyethylene Glycol With Ascorbic Acid and an Oral Sulfate Solution in a Split Method for Bowel Preparation: A Randomized, Multicenter Phase III Clinical Trial. Dis Colon Rectum 2017; 60:426-432. [PMID: 28267011 DOI: 10.1097/dcr.0000000000000759] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND An adequate level of bowel preparation before colonoscopy is important. The ideal agent for bowel preparation should be effective and tolerable. OBJECTIVE The purpose of this study was to compare the clinical efficacy and tolerability of polyethylene glycol with ascorbic acid and oral sulfate solution in a split method for bowel preparation. DESIGN This was a prospective, multicenter, randomized controlled clinical trial. SETTINGS Outpatients at the specialized clinics were included. PATIENTS A total of 186 subjects were randomly assigned. After exclusions, 84 subjects in the polyethylene glycol with ascorbic acid group and 83 subjects in the oral sulfate solution group completed the study and were analyzed. INTERVENTIONS Polyethylene glycol with ascorbic acid or oral sulfate solution in a split method was the included intervention. MAIN OUTCOME MEASURES The primary end point was the rate of successful bowel preparation, which was defined as being excellent or good on the Aronchick scale. Tolerability and adverse events were also measured. RESULTS Success of bowel preparation was not different between 2 groups (91.7% vs 96.4%; p = 0.20), and the rate of adverse GI events (abdominal distension, pain, nausea, vomiting, or abdominal discomfort) was not significantly different between the 2 groups. In contrast, the mean intensity of vomiting was higher in the oral sulfate solution group than in the polyethylene glycol with ascorbic acid group (1.6 ± 0.9 vs 1.9 ± 1.1; p = 0.02). LIMITATIONS All of the colonoscopies were performed in the morning, and the subjects were offered enhanced instructions for bowel preparation. In addition, the results of tolerability and adverse effect may have a type II error, because the number of cases was calculated for confirming the efficacy of bowel preparation. CONCLUSIONS Oral sulfate solution is effective at colonoscopy cleansing and has acceptable tolerability when it is compared with polyethylene glycol with ascorbic acid. The taste and flavor of oral sulfate solution still need to be improved to enhance tolerability.
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Walter J, Francis G, Matro R, Kedika R, Grosso R, Keith SW, Kastenberg D. The impact of diet liberalization on bowel preparation for colonoscopy. Endosc Int Open 2017; 5:E253-E260. [PMID: 28382323 PMCID: PMC5375955 DOI: 10.1055/s-0043-101694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and study aims Dietary restrictions are integral to colonoscopy preparation and impact patient satisfaction. Utilizing split-dose, lower-volume polyethylene glycol 3350-electrolyte solution (PEG-ELS), this study compared colon preparation adequacy of a low-residue diet to clear liquids using a validated grading scale. Patients and methods This was a prospective, randomized, single-blinded, single-center non-inferiority study evaluating diet the day prior to outpatient colonoscopy. Subjects were randomized to a Low-Residue diet for breakfast and lunch, or Clears only. All subjects received split dose PEG-ELS. The primary endpoint was preparation adequacy using the Boston Bowel Preparation Scale (BBPS), with adequate defined as a score > 5. Secondary endpoints included mean BBPS scores for the entire colon and individual segments, satisfaction, adverse events, polyp and adenoma detection rates, and impact on sleep and daily activities. Results Final analysis included 140 subjects, 72 assigned to Clears and 68 to Low-Residue. The Low-Residue diet was non-inferior to Clears (risk difference = - 5.08 %, P = 0.04) after adjusting for age. Mean colon cleansing scores were not significantly different overall and for individual colonic segments. Satisfaction with the Low-Residue diet was significantly greater (P = 0.01). The adenoma detection rate was not statistically significantly different between study groups, but the number of adenomas detected was significantly greater with Clears (P = 0.01). Adverse events and impact on sleep and activities did not differ significantly between diet arms. Conclusions A low-residue diet for breakfast and lunch the day prior to colonoscopy was non-inferior to clear liquids alone for achieving adequate colon cleansing when using split dose PEG-ELS.
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Affiliation(s)
- James Walter
- Department of Gastroenterology, Cooper University, Mount Laurel, New Jersey, United States,Corresponding author James Walter, MD 501 Fellowship RoadSuite 101Mount Laurel, NJ, United States 08054+1-856-642-2133
| | - Gloria Francis
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Rebecca Matro
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Ramalinga Kedika
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Rachael Grosso
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Scott W. Keith
- Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - David Kastenberg
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
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22
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Simethicone residue remains inside gastrointestinal endoscopes despite reprocessing. Am J Infect Control 2016; 44:1237-1240. [PMID: 27497824 DOI: 10.1016/j.ajic.2016.05.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND During a study designed to assess endoscope reprocessing effectiveness, a borescope was used to examine lumens and ports. Cloudy, white, viscous fluid was observed inside fully reprocessed gastroscopes and colonoscopes. This fluid resembled simethicone, which is commonly administered to reduce foam and bubbles that impede visualization during gastrointestinal endoscopy. This article describes methods used to determine whether the observed fluid contained simethicone. METHODS Photographs of residual fluid were taken using a borescope. Sterile cotton-tipped swabs were used to collect samples of fluid observed in 3 endoscope ports. Samples were evaluated using Fourier transform infrared spectroscopy (FTIR)-attenuated total reflection analysis. RESULTS Residual fluid was observed inside 19 of 20 endoscopes. Fluid photographed in 8 endoscopes resembled simethicone solutions. FTIR analysis confirmed the presence of simethicone in 2 endoscopes. CONCLUSIONS Fluid containing simethicone remained inside endoscopes despite reprocessing. Simethicone is an inert, hydrophobic substance that may reduce reprocessing effectiveness. Simethicone solutions commonly contain sugars and thickeners, which may contribute to microbial growth and biofilm development. Studies are needed to assess the prevalence of residual moisture and simethicone in endoscopes and determine the impact on reprocessing effectiveness. We recommend minimizing the use of simethicone pending further research into its safety.
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Ogino N, Aridome G, Oshima J, Shibata M, Watanabe T, Kume K, Yoshikawa I, Harada M. Serum Albumin Concentrations Predict hypovolaemia Caused by Polyethylene Glycol Plus Ascorbic Acid Prior to Colonoscopy in Elderly Patients. Drugs Aging 2016; 33:355-63. [PMID: 26895453 DOI: 10.1007/s40266-016-0355-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies have confirmed the safety of polyethylene glycol plus ascorbic acid for healthy middle-aged adults but not for the elderly. The osmotic pressure of polyethylene glycol plus ascorbic acid is approximately twice that of plasma osmolality and may cause dehydration. OBJECTIVE In this study, we determined whether dehydration was induced in elderly patients by polyethylene glycol plus ascorbic acid, and we analysed the data obtained in order to identify predictors of dehydration. METHODS This was a prospective, uncontrolled, before-and-after intervention study. All patients older than 65 years who underwent colonoscopies at the Moji Medical Center were administered polyethylene glycol plus ascorbic acid prior to colonoscopy. Clinical variables before and after bowel preparation were measured and analysed statistically. A multiple linear regression analysis was performed to identify predictors of dehydration due to this procedure. RESULTS Eighty-three patients were assessed for eligibility, and 74 clinical variables were ultimately analysed. A significant increase in the red blood cell count (4.10 versus 4.25 × 10(6)/mm(3)), haemoglobin level (12.4 versus 13.0 g/dL) and haematocrit (38.1% versus 39.4%) suggested the presence of hypovolaemia after the procedure (P < 0.001). The serum concentration of albumin before bowel preparation was identified as the only significant predictor of hypovolaemia (β = 0.47, P = 0.0001, adjusted R (2) = 0.22). CONCLUSION The serum concentration of albumin before bowel preparation predicted hypovolaemia caused by polyethylene glycol plus ascorbic acid in elderly patients. Therefore, care is needed in order to prevent hypovolaemia, especially in elderly patients with hypoalbuminaemia. TRIAL REGISTRATION No. 000015724 (University Hospital Medical Information Network Center).
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Affiliation(s)
- Noriyoshi Ogino
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan. .,Department of Internal Medicine, Moji Medical Center, Kitakyushu, Japan.
| | - Gentaro Aridome
- Department of Internal Medicine, Moji Medical Center, Kitakyushu, Japan.,Department of Gastroenterology, Wakamatsu Hospital of University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Junji Oshima
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.,Department of Internal Medicine, Moji Medical Center, Kitakyushu, Japan
| | - Michihiko Shibata
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Tatsuyuki Watanabe
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Keiichiro Kume
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Ichiro Yoshikawa
- Department of Endoscopy, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Masaru Harada
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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Kim MJ, Hong CW, Kim BC, Park SC, Han KS, Joo J, Oh JH, Sohn DK. Phase II Randomized Controlled Trial of Combined Oral laxatives Medication for BOwel PREParation (COMBO-PREP study). Medicine (Baltimore) 2016; 95:e2824. [PMID: 26886637 PMCID: PMC4998637 DOI: 10.1097/md.0000000000002824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The combination of different laxatives at reduced volumes may benefit patients by enhancing efficacy for bowel cleansing and increasing tolerability. However, evidence regarding combined preparations is scarce. This study evaluated whether the combined preparations are associated with enhanced efficacy and tolerability. This randomized phase II study had a single-blind, parallel-arm design. Between December 2013 and September 2014, consecutive patients aged between 20 and 65 years and who required diagnostic colonoscopies were considered for inclusion. Patients were randomly allocated into 4 arms: sodium picosulfate and magnesium citrate (PMC) and polyethylene glycol (PEG) with ascorbic acid in a day-prior (PMC-PEG-DP), PMC and oral sodium phosphate (NaP) in a day-prior (PMC-NaP-DP), PMC and PEG with ascorbic acid in a split-dose (PMC-PEG-SD), and PMC and oral NaP in a split-dose (PMC-NaP-SD). Primary endpoint was the Aronchick scale, and Ottawa scale results by colon segment, patients' adverse gastrointestinal symptoms, and willingness to reuse the same agents were also recorded. Successful bowel preparation was defined as an "excellent" or "good" score on the Aronchick scale. A total of 236 patients were randomized and 229 patients received the planned colonoscopy. The rates of successful bowel preparation in the PMC-PEG-DP, PMC-NaP-DP, PMC-PEG-SD, and PMC-NaP-SD were 82.5%, 64.4%, 100%, and 100%, respectively. Excluding the failed PMC-NaP-DP group, all groups showed satisfactory rates of successful bowel preparation, and the mean Ottawa scores were significantly better in the PMC-PEG-SD and PMC-NaP-SD groups than in the PMC-PEG-DP group (P < 0.0001). The PMC-PEG-DP, PMC-NaP-DP, PMC-PEG-SD, and PMC-NaP-SD groups were similar in terms of rates of adverse gastrointestinal symptoms reported on a 5-point scale (P = 0.40) and willingness to reuse the same combined preparations (P = 0.55). PMC-PEG in a day-prior or split-dose and PMC-NaP in a split-dose were efficient and tolerable bowel preparations for colonoscopy.
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Affiliation(s)
- Min Jung Kim
- From the Center for Colorectal Cancer (MJK, CWH, BCK, SCP, KSH, JHO, DKS) and Biometric Research Branch (JJ), Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Rotondano G, Rispo A, Bottiglieri ME, De Luca L, Lamanda R, Orsini L, Bruzzese D, Galloro G, Romano M, Miranda A, Loguercio C, Esposito P, Nardone G, Compare D, Magno L, Ruggiero S, Imperatore N, De Palma GD, Gennarelli N, Cuomo R, Passananti V, Cirillo M, Cattaneo D, Bozzi RM, D'Angelo V, Marone P, Riccio E, De Nucci C, Monastra S, Caravelli G, Verde C, Di Giorgio P, Giannattasio F, Capece G, Taranto D, De Seta M, Spinosa G, De Stefano S, Familiari V, Cipolletta L, Bianco MA, Sansone S, Galasso G, De Colibus P, Romano M, Borgheresi P, Ricco G, Martorano M, Gravina AG, Marmo R, Rea M, Maurano A, Labianca O, Colantuoni E, Iuliano D, Trovato C, Fontana A, Pasquale L, Morante A, Perugini B, Scaglione G, Mauro B. Quality of bowel cleansing in hospitalized patients undergoing colonoscopy: A multicentre prospective regional study. Dig Liver Dis 2015; 47:669-74. [PMID: 26028360 DOI: 10.1016/j.dld.2015.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/13/2015] [Accepted: 04/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quality of bowel cleansing in hospitalized patients undergoing colonoscopy is often unsatisfactory. No study has investigated the inpatient or outpatient setting as cause of inadequate cleansing. AIMS To assess degree of bowel cleansing in inpatients and outpatients and to identify possible predictors of poor bowel preparation in the two populations. METHODS Prospective multicentre study on consecutive colonoscopies in 25 regional endoscopy units. Univariate and multivariate analysis with odds ratio estimation were performed. RESULTS Data from 3276 colonoscopies were analyzed (2178 outpatients, 1098 inpatients). Incomplete colonoscopy due to inadequate cleansing was recorded in 369 patients (11.2%). There was no significant difference in bowel cleansing rates between in- and outpatients in both colonic segments. In the overall population, independent predictors of inadequate cleansing both at the level of right and left colon were: male gender (odds ratio, 1.20 [1.02-1.43] and 1.27 [1.05-1.53]), diabetes mellitus (odds ratio, 2.35 [1.68-3.29] and 2.12 [1.47-3.05]), chronic constipation (odds ratio, 1.60 [1.30-1.97] and 1.55 [1.23-1.94]), incomplete purge intake (odds ratio, 2.36 [1.90-2.94] and 2.11 [1.68-2.65]) and a runway time >12h (odds ratio, 3.36 [2.40-4.72] and 2.53 [1.74-3.67]). CONCLUSIONS We found no difference in the rate of inadequate bowel preparation between hospitalized patients and outpatients.
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Affiliation(s)
- Gianluca Rotondano
- Division of Gastroenterology and Digestive Endoscopy, Maresca Hospital, Torre del Greco, Italy.
| | - Antonio Rispo
- Gastroenterology Unit, Department of Gastroenterology, Surgery and Endocrinology, "Federico II" University Hospital, Napoli, Italy
| | | | - Leonardo De Luca
- Gastroenterology and Digestive Endoscopy Unit, Pellegrini Hospital, Napoli, Italy
| | - Roberto Lamanda
- Gastroenterology Unit, S.M. delle Grazie Hospital, Pozzuoli, Italy
| | - Luigi Orsini
- Gastroenterology Unit, Cardarelli Hospital, Napoli, Italy
| | - Dario Bruzzese
- Department of Public Health, University "Federico II" School of Medicine, Napoli, Italy
| | - Giuseppe Galloro
- Department of Clinical Medicine and Surgery, Surgical Digestive Endoscopy Unit, University "Federico II" School of Medicine, Napoli, Italy
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Tae CH, Jung SA, Na SK, Song HK, Moon CM, Kim SE, Shim KN, Jung HK, Moon IH. The use of low-volume polyethylene glycol containing ascorbic acid versus 2 L of polyethylene glycol plus bisacodyl as bowel preparation for colonoscopy. Scand J Gastroenterol 2015; 50:1039-44. [PMID: 25862428 DOI: 10.3109/00365521.2014.1000961] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Low-volume polyethylene glycol (PEG) bowel preparations have been developed to improve compliance for colonoscopy. Our study aimed to compare the efficacy and tolerability of low-volume PEG containing ascorbic acid for colonoscopy against 2 L of PEG plus bisacodyl. METHODS We prospectively enrolled consecutive inpatients who had not undergone polypectomy at the index colonoscopy and were subsequently referred for polypectomy at our hospital. A total of 62 patients were randomized to receive either low-volume PEG containing ascorbic acid (n = 31) or 2 L of PEG plus bisacodyl (n = 31) as a split-dose regimen in inpatients. The efficacy of preparation was determined using the Ottawa Bowel Preparation Score (OBPS) and a 4-point scale. Adverse events, tolerability, and willingness were evaluated using a questionnaire. RESULTS Based on the OBPS and 4-point scale, we determined that the efficacy of low-volume PEG containing ascorbic acid was comparable to that of the 2 L of PEG plus bisacodyl (p = 0.071 for OBPS, p = 0.056 for the 4-point scale). Adverse events were comparable between the two groups (p = 1.000). A greater proportion of patients in the low-volume PEG containing ascorbic acid (90.6%) and the 2L of PEG plus bisacodyl (96.9%) were willing to repeat the same preparation for subsequent colonoscopy. CONCLUSION Low-volume PEG containing ascorbic acid had comparable efficacy and tolerability to 2 L of PEG plus bisacodyl, when given as a split dose, for colonoscopy in inpatients. Split-dose low-volume PEG containing ascorbic acid is a good alternative for bowel preparation for colonoscopy in inpatients.
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Affiliation(s)
- Chung Hyun Tae
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine , Seoul , Korea
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Saltzman JR, Cash BD, Pasha SF, Early DS, Muthusamy VR, Khashab MA, Chathadi KV, Fanelli RD, Chandrasekhara V, Lightdale JR, Fonkalsrud L, Shergill AK, Hwang JH, Decker GA, Jue TL, Sharaf R, Fisher DA, Evans JA, Foley K, Shaukat A, Eloubeidi MA, Faulx AL, Wang A, Acosta RD. Bowel preparation before colonoscopy. Gastrointest Endosc 2015; 81:781-94. [PMID: 25595062 DOI: 10.1016/j.gie.2014.09.048] [Citation(s) in RCA: 267] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 01/10/2023]
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Kim HG, Jeon SR, Kim MY, Lee TH, Cho JH, Ko BM, Kim JO, Cho JY, Lee JS. How to predict adequate bowel preparation before colonoscopy using conventional polyethylene glycol: prospective observational study based on survey. Dig Endosc 2015; 27:87-94. [PMID: 24833415 DOI: 10.1111/den.12312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/09/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIM The present study investigated the conditions and predictive factors for adequate bowel preparation using 4-L polyethylene glycol (PEG) preparation in clinical practice. METHODS We conducted a prospective-survey-based observational study. The survey consisted of 14 questions that assessed the preparation method (group 1: split method for morning colonoscopy; group 2: full-volume method for same-day afternoon colonoscopy; group 3: full-volume method for next-day morning colonoscopy), dinner type and timing the day before colonoscopy, elapsed time after PEG consumption, and stool character and defecation frequency immediately before colonoscopy. Preparation status was compared using the Boston bowel preparation scale (BBPS). RESULTS Total of 465 surveys (391 for group 1, 55 for group 2, 19 for group 3) were conducted. Mean BBPS score was highest in group 1 and lowest in group 3 (P < 0.001). Fasting dinner before colonoscopy group showed a higher mean BBPS than the diet group; eating before 6 p.m. and a low-residue diet showed a higher mean BBPS (P < 0.05). Defecation frequency (>5 times) was related to adequate preparation in the left colon and elapsed time (<5 h) to that in the right colon (P < 0.05). Liquid stool without solid material immediately before colonoscopy was related to adequate preparation (P < 0.001). CONCLUSION In bowel preparation with 4-L PEG, elapsed time after PEG consumption (<5 h), defecation frequency (>5 times) and liquid stool without solid material immediately before colonoscopy were predictive factors for adequate bowel preparation just before colonoscopy.
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Affiliation(s)
- Hyun Gun Kim
- Institute for Digestive Research, Soonchunhyang University, College of Medicine, Seoul, Korea
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Polyethylene Glycol Electrolyte Lavage Solution versus Colonic Hydrotherapy for Bowel Preparation before Colonoscopy: A Single Center, Randomized, and Controlled Study. Gastroenterol Res Pract 2014; 2014:541586. [PMID: 24995014 PMCID: PMC4068103 DOI: 10.1155/2014/541586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/09/2014] [Accepted: 05/16/2014] [Indexed: 01/15/2023] Open
Abstract
This single center, randomized, and controlled study aimed to compare the effectiveness and safety of polyethylene glycol electrolyte lavage (PEG-EL) solution and colonic hydrotherapy (CHT) for bowel preparation before colonoscopy. A total of 196 eligible outpatients scheduled for diagnostic colonoscopy were randomly assigned to the PEG-EL (n = 102) or CHT (n = 94) groups. Primary outcome measures included colonic cleanliness and adverse effects. Secondary outcome measures were patient satisfaction and preference, colonoscopic findings, ileocecal arrival rate, examiner satisfaction, and cecal intubation time. The results show that PEG-EL group was associated with significantly better colonic cleanliness than CHT group, fewer adverse effects, and increased examiner satisfaction. However, the CHT group had higher patient satisfaction and higher diverticulosis detection rates. Moreover, the results showed the same ileocecal arrival rate and patient preference between the two groups (P > 0.05). These findings indicate that PEG-EL is the preferred option in patients who followed the preparation instructions completely.
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Landreneau SW, Di Palma JA. Colon cleansing for colonoscopy 2013: current status. Curr Gastroenterol Rep 2014; 15:341. [PMID: 23852571 DOI: 10.1007/s11894-013-0341-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Colonoscopy requires adequate bowel cleansing to be safe and effective. There are a variety of options available. This review will focus on highlighting new products, administration techniques emphasizing the value of split-dose and same-day regimens, safety, and options for inadequate cleansing.
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Affiliation(s)
- Stephen W Landreneau
- Section of Gastroenterology, Louisiana State University School of Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
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Bang KB, Jeong EH, Jeong WS, Chae HB, Kim NH, Lee TH, Kim JY, Jung YS, Park JH, Sohn CI, Choi KY, Park DI. Efficacy of Bisacodyl Given as Part of a Polyethylene Glycol-based Bowel Preparation Prior to Colonoscopy in Hospitalized Patients: A Prospective Ramdomized Trial. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 64:268-77. [DOI: 10.4166/kjg.2014.64.5.268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ki Bae Bang
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Haeng Jeong
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Shin Jeong
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Beom Chae
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam Hee Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yeon Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Suk Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yong Choi
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kushnir VM, Bhat P, Chokshi RV, Lee A, Borg BB, Gyawali CP, Sayuk GS. The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy. Dig Liver Dis 2014; 46:56-61. [PMID: 24012559 PMCID: PMC4017778 DOI: 10.1016/j.dld.2013.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/03/2013] [Accepted: 07/31/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Suboptimal colon preparation is a significant barrier to quality colonoscopy. The impact of pharmacologic agents associated with gastrointestinal dysmotility on quality of colon preparation has not been well characterized. AIMS Evaluate impact of opiate pain medication and psychoactive medications on colon preparation quality in outpatients undergoing colonoscopy. METHODS Outpatients undergoing colonoscopy at a single medical centre during a 6-month period were retrospectively identified. Demographics, clinical characteristics and pharmacy records were extracted from electronic medical records. Colon preparation adequacy was evaluated using a validated composite colon preparation score. RESULTS 2600 patients (57.3 ± 12.9 years, 57% female) met the inclusion and exclusion criteria. 223 (8.6%) patients were regularly using opioids, 92 antipsychotics, 83 tricyclic antidepressants and 421 non-tricyclic antidepressants. Opioid use was associated with inadequate colon preparation both with low dose (OR = 1.4, 95%CI 1.0-2.1, p = 0.05) and high dose opioid users (OR = 1.7, 95%CI 1.1-2.9, p = 0.039) in a dose dependent manner. Other significant predictors of inadequate colon preparation included use of tricyclics (OR = 1.9, 95%CI 1.1-3.0, p = 0.012), non-tricyclic antidepressants (OR = 1.5, 95%CI 1.1-2.0, p = 0.013), and antipsychotic medications (OR = 2.2, 95%CI 1.4-3.4, p = 0.001). CONCLUSIONS Opiate pain medication use independently predicts inadequate quality colon preparation in a dose dependent fashion; furthermore psychoactive medications have even more prominent effects and further potentiates the negative impact of opiates with concurrent use.
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Affiliation(s)
- Vladimir M Kushnir
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - Pavan Bhat
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - Reena V Chokshi
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - Alexander Lee
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - Brian B Borg
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.
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Manes G, Amato A, Arena M, Pallotta S, Radaelli F, Masci E. Efficacy and acceptability of sodium picosulphate/magnesium citrate vs low-volume polyethylene glycol plus ascorbic acid for colon cleansing: a randomized controlled trial. Colorectal Dis 2013; 15:1145-53. [PMID: 23581277 DOI: 10.1111/codi.12246] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/15/2012] [Indexed: 12/12/2022]
Abstract
AIM The study compared the efficacy, safety and tolerability of a low-volume picosulphate/magnesium citrate preparation with that of polyethylene glycol plus ascorbic acid (PEG + ASC) in a randomized clinical trial (RCT). METHOD A multicentre randomized, single-blinded study was designed. Adult outpatients undergoing colonoscopy received either picosulphate/magnesium citrate (Group 1) or PEG + ASC (Group 2). Bowel cleansing was assessed using the Boston Bowel Preparation Scale (BBPS) and rated as adequate if ≥ 2 in each segment. Patient acceptance, satisfaction and related symptoms were recorded. RESULTS Two-hundred and eighty-five patients were included. Preparation was adequate in 75.7% of patients in Group 1 and in 76.5% of patients in Group 2. The mean BBPS scores for the entire colon and for the right colon were comparable between groups. In addition, 97.1% patients in Group 1 and 84.8% in Group 2 reported no or mild discomfort (P < 0.0003) and 97.8% and 83.4% expressed their willingness to repeat the preparation (P < 0.0001). Palatability was better in Group 1, whereas related symptoms occurred more frequently in Group 2. Regardless of which preparation was used, the split regimen was associated with better cleansing compared with the same-day method (OR = 3.39; 95% CI: 1.1-10.4; P = 0.03). Other predictors of poor cleansing were comorbidity, discomfort during preparation and incomplete (< 75%) preparation. CONCLUSION Both picosulphate/magnesium citrate and PEG + ASC are effective for bowel preparation. Tolerability and palatability are better for picosulphate/magnesium citrate. A split schedule is associated with higher cleansing quality also for low-volume regimens.
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Affiliation(s)
- G Manes
- Gastrointestinal Endoscopy Unit, University Hospital L. Sacco, Milan, Italy
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Chandrasekhara V, Early DS, Acosta RD, Chathadi KV, Decker GA, Evans JA, Fanelli RD, Fisher DA, Foley KQ, Fonkalsrud L, Hwang JH, Jue T, Khashab MA, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD. Modifications in endoscopic practice for the elderly. Gastrointest Endosc 2013; 78:1-7. [PMID: 23664042 DOI: 10.1016/j.gie.2013.04.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/12/2022]
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A new colonic lavage system to prepare the colon for colonoscopy: a retrospective study. Tech Coloproctol 2012; 17:39-44. [PMID: 22936584 DOI: 10.1007/s10151-012-0876-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 08/09/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND One of the most unpleasant and sometimes difficult elements of colonoscopic examination is the bowel preparation which is usually performed 6 or more hours prior to the examination ("early" preparation), causing many patients to refrain from undergoing this procedure. We present a novel technique for bowel preparation that begins approximately 30 min prior to the introduction of the colonoscope and eliminates the need for significant pre-procedure preparation. METHODS The medical records of all consecutive patients who underwent colonoscopy without "early" preparation (CWEP) from May 2009 through June 2010 were retrospectively reviewed. The procedure was performed using a novel cleansing device, the "ColonoScoPrep™", with which the colon is prepared about half an hour prior to insertion of the colonoscope. The only medication required is two to three bisacodyl tablets the night before. The quality of bowel preparation was graded as excellent, good, satisfactory, or poor, and patient satisfaction was assessed according to a prospective protocol. RESULTS During this period, 125 patients underwent CWEP. Of these, 110 (89.4 %) patients had an excellent or good preparation, permitting complete colonoscopic examination unimpeded by fecal matter. In 11 patients, preparation was satisfactory, in 2 it was poor and in 2, colonoscopy was not completed due to unsatisfactory preparation. None of the patients suffered from abdominal pain or cramps during or after the CWEP and none had post-colonoscopy diarrhea. All patients were satisfied with the procedure. CONCLUSIONS Despite the fact that the study is retrospective, CWEP appears safe and easy to perform. A prospective study comparing conventional bowel preparation and CWEP is now underway.
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Trastulli S, Barillaro I, Desiderio J, DI Rocco G, Cochetti G, Mecarelli V, Cirocchi R, Santoro A, Boselli C, Redler A, Avenia N, Noya G. Colonic explosion during treatment of radiotherapy complications in prostatic cancer. Oncol Lett 2012; 4:915-918. [PMID: 23162622 DOI: 10.3892/ol.2012.873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 04/20/2012] [Indexed: 11/05/2022] Open
Abstract
The use of lasers has been of great importance in the field of endoscopy and surgery for their applications in coagulation and the ability to vaporize tissue. In the 1990s, new machines were introduced based on a different technology, the argon-plasma-coagulation (APC) system. This technology causes different biological effects without direct contact. An example is the hemostasis of bleeding. In the literature, several cases of complications have been reported during endoscopic treatment with APC. In this study, we report our experience of a case with colon explosion during an APC procedure for bleeding due to radiotherapy and also review the literature on the complications of APC treatment.
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Samarasena JB, Muthusamy VR, Jamal MM. Split-dosed MiraLAX/Gatorade is an effective, safe, and tolerable option for bowel preparation in low-risk patients: a randomized controlled study. Am J Gastroenterol 2012; 107:1036-42. [PMID: 22565162 DOI: 10.1038/ajg.2012.115] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES MiraLAX with Gatorade is a low-volume bowel preparation regimen that has been used widely in community practice and is anecdotally better tolerated than Golytely. Despite its widespread use, there are little data on the efficacy and tolerability of this solution and no safety data in the literature. The primary aim of this study was to compare the efficacy, safety, and tolerability of single-dosed and split-dosed regimens of MiraLAX/Gatorade with Golytely for bowel preparation before colonoscopy. METHODS Adults presenting for outpatient colonoscopy were screened for enrollment into this single-blinded randomized controlled trial. Patients with severe cardiac or renal disease and patients with electrolyte abnormalities were excluded. Subjects were randomized into four groups: 4 l Golytely single-dosed (Go-Si), 4 l Golytely split-dosed (Go-Sp), 238 g MiraLAX in 64 oz of Gatorade single-dosed (Mlax-Si), and MiraLAX/Gatorade split-dosed (Mlax-Sp) groups. Laboratory data including complete blood count, comprehensive metabolic panel, and osmolality were collected before the day of bowel preparation and just before the start of colonoscopy. Subjects completed a survey assessing taste and tolerability of the solution. Colonoscopies were recorded using video recording software and de-identified. Colonoscopy videos were evaluated for efficacy of cleansing by two blinded endoscopists. Two validated bowel preparation scales were used to assess bowel cleansing: the Boston Bowel Preparation Scale (BBPS; 0-9 best) and Ottawa Scale (0-14 worst). RESULTS A total of 222 patients were evaluated in this study (86.2% male, mean age 59.4). Of these, 57 subjects were randomized to the Go-Si group, 51 to Go-Sp group, 60 to Mlax-Si group, and 54 to Mlax-Sp group. There was no significant difference in age, gender, or timing of colonoscopy between the groups (P>0.05). Mean BBPS scores were: Go-Si=6.07, Go-Sp=8.33, Mlax-Si=6.62, and Mlax-Sp=8.01. Mean Ottawa score for the groups were: Go-Si group=6.77, Go-Sp=4.12, Mlax-Si=6.25, and Mlax-Sp=4.8. Go-Sp resulted in significantly better cleansing than Go-Si (P<0.01). Mlax-Sp resulted in significantly better cleansing than Mlax-Si (P<0.01). There was no significant difference in BBPS between Go-Sp and Mlax-Sp. There were no clinically significant electrolyte changes from baseline in any subject in any group after bowel prep (P>0.05). Subjects rated the taste and overall experience of Mlax/Gatorade preparation better than Golytely (P<0.01). In all, 96.8% of Mlax/Gatorade subjects were willing to repeat the same preparation vs. 75% for Golytely subjects (P<0.01). CONCLUSIONS Split-dosed MiraLAX/Gatorade was an effective, safe, and tolerable option for bowel preparation before colonoscopy in the low-risk patients in this study. MiraLAX/Gatorade appears to be more tolerable than Golytely as a bowel cleansing regimen and was the preferred agent by the patients in this study.
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Affiliation(s)
- Jason B Samarasena
- Department of Gastroenterology, Long Beach Veterans Affairs Healthcare system, Long Beach, CA 90822, USA
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Manno M, Pigò F, Manta R, Barbera C, Bertani H, Mirante VG, Dabizzi E, Caruso A, Olivetti G, Hassan C, Zullo A, Conigliaro R. Bowel preparation with polyethylene glycol electrolyte solution: optimizing the splitting regimen. Dig Liver Dis 2012; 44:576-9. [PMID: 22456624 DOI: 10.1016/j.dld.2012.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/06/2012] [Accepted: 02/19/2012] [Indexed: 12/11/2022]
Abstract
AIM Quality of bowel cleansing significantly increases the shorter the time between bowel solution intake and endoscopic examination. We tested the efficacy and patient tolerability following a modified polyethylene glycol electrolyte (PEG) splitting regimen. METHODS This was a prospective, single-blind, randomized, study. Patients were assigned to receive either PEG 4 L the afternoon before colonoscopy or PEG 3 L the day before and 1 L 3h before the procedure the day of colonoscopy. RESULTS The study population consisted of 336 patients, including 168 participants in each study arm. Although the bowel preparation quality was similarly quoted as excellent/good following the split and full regimen (95.2% vs 92.8%; p=0.3), a significant (p<0.0001) shift from good towards an excellent preparation (26.8% vs 68.4%) was observed following the split regimen as compared to the full regimen (55.4% vs 37.5%). The incidence of side-effects did not differ. When patients were asked about a future preparation if needed, 69% and 31% following the split and full regimen, respectively, declared to accept again the same preparation, the difference being statistically significant (p<0.001). CONCLUSIONS Our data found that an excellent bowel cleansing could be frequently achieved by simply modifying the split regimen from the standard PEG 2 plus 2 L to 3 plus 1 L.
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Affiliation(s)
- Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S.Agostino-Estense - Baggiovara di Modena, Modena, Italy.
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Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA. Complications of colonoscopy. Gastrointest Endosc 2011; 74:745-52. [PMID: 21951473 DOI: 10.1016/j.gie.2011.07.025] [Citation(s) in RCA: 234] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 07/15/2011] [Indexed: 12/17/2022]
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Yarze JC, Chase MP. Avoidance of PEG 3350 in patients with CHF, cirrhosis, and chronic kidney disease. Gastrointest Endosc 2011; 74:236-7; author reply 237. [PMID: 21704825 DOI: 10.1016/j.gie.2011.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 12/11/2022]
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Adamcewicz M, Bearelly D, Porat G, Friedenberg FK. Mechanism of action and toxicities of purgatives used for colonoscopy preparation. Expert Opin Drug Metab Toxicol 2011; 7:89-101. [PMID: 21162694 DOI: 10.1517/17425255.2011.542411] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE OF THE FIELD In developed countries, colonoscopy volume has increased dramatically over the past 15 years and is the principle method used to screen for colon cancer. Preparations used for colon cleaning have evolved over the past 30 years. Some preparations have been shown to be unsafe and are now used on a limited basis. There has been progress on limiting the volume required and on taste improvement. AREAS COVERED IN THIS REVIEW This review provides an account of preparations used from 1980 when PEG-based preparations became widely available, until the present day. The review highlights their mechanism of action and principle toxicities. The handling of solutes and solute-free fluid by the colon is also reviewed. WHAT THE READER WILL GAIN The reader will gain a perspective on the factors considered in developing colonic purgatives and the rationale for choosing selected preparations based on patient factors such as age, co-morbidities and concomitant medications. TAKE HOME MESSAGE Although generally safe and effective, colonic purgatives have both acute and permanent toxicities. The safest preparations utilize PEG combined with a balanced electrolyte solution. Limitations of this preparation center on the volume required and poor taste. Alternative formulations are now available; however, those using sodium phosphate have fallen out of favor due to a risk of renal toxicity.
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Affiliation(s)
- Margaret Adamcewicz
- Temple University School of Medicine, Department of Medicine, Section of Gastroenterology, Philadelphia, PA 19140, USA
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Abstract
Colonoscopy requires adequate bowel cleansing to be safe and effective. Current options for preparation include dietary restrictions plus cathartics and purgatives, large-volume gut lavage solutions, and sodium phosphate preparations. Gut lavage with or without a stimulant laxative is safe and effective, and traditionally is taken the evening before the procedure. Sodium phosphate formulations also provide effective cleansing, but fluid and electrolyte disturbances can occur. Recent advances include split administration of gut lavage solutions-ingesting only half of the solution the evening prior to, and the rest the morning of, the procedure. Split administration can yield adequate preparations in inpatients, traditionally a difficult group for proper cleansing. A new oral sulfate solution, when commercially available, should provide safe, effective cleaning with a lower ingested volume. This review discusses the current clinical experience of available preparation options and the efforts to make preparation for colonoscopy more tolerable.
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Affiliation(s)
- Stephen W Landreneau
- Division of Gastroenterology, College of Medicine, University of South Alabama, Mobile, AL 36693, USA.
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Abstract
Efficient cleansing of the colon before a colonoscopy or a radiological examination is essential. The osmotically acting cathartics (those given the Anatomical Therapeutic Chemical code A06AD) currently used for this purpose comprise products based on three main substances: sodium phosphate, combinations of polyethylene glycol and electrolyte lavage solutions (PEG-ELS), and magnesium citrate. All these preparations give adequate cleansing results and have similar profiles in terms of the frequency and type of mild to moderate adverse effects. However, serious adverse events, such as severe hyperphosphatemia and irreversible kidney damage owing to acute phosphate nephropathy, have been reported after use of sodium-phosphate-based products. The aim of this Review is to provide an update on the potential safety issues related to the use of osmotically acting cathartics, especially disturbances of renal function and water and electrolyte balance. The available evidence indicates that PEG-ELS-based products are the safest option. Magnesium-citrate-based, hypertonic products should be administered with caution to elderly individuals and patients who are prone to develop disturbances in water and electrolyte balance. Sodium-phosphate-based products can occasionally cause irreversible kidney damage and should not be routinely used in bowel-cleansing procedures.
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Marmo R, Rotondano G, Riccio G, Marone A, Bianco MA, Stroppa I, Caruso A, Pandolfo N, Sansone S, Gregorio E, D'Alvano G, Procaccio N, Capo P, Marmo C, Cipolletta L. Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low-volume polyethylene glycol solutions. Gastrointest Endosc 2010; 72:313-20. [PMID: 20561621 DOI: 10.1016/j.gie.2010.02.048] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 02/25/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Adequate bowel cleansing is essential for a high-quality, effective, and safe colonoscopy. OBJECTIVES To evaluate the degree of colon cleansing comparing split-dosage versus non-split-dosage intake of two different polyethylene glycol (PEG) volumes (low-volume PEG + ascorbic acid vs standard-volume PEG-electrolyte solution) and to identify predictors of poor bowel cleansing. DESIGN Single-blind, active control, randomized study. SETTING Tertiary-care institutions in Italy. PATIENTS This study involved adult patients undergoing elective colonoscopy. INTERVENTION Colonoscopy with different bowel preparation methods. MAIN OUTCOME MEASUREMENTS Degree of bowel cleansing. RESULTS We randomized 895 patients, and 868 patients were finally included in intention-to-treat (ITT) analysis. Overall compliance was excellent (97%) for both preparation methods. No difference in tolerability was recorded. Palatability was superior with low volume compared with high volume (acceptable or good 58% vs 51%, respectively, P < .005), independently of intake schedule. PEG plus ascorbic acid produced the same degree of cleansing as standard-volume PEG-electrolyte solution (77% vs 73.4%, respectively, within the split-dosage group and 41.7% vs 44.3%, respectively, within the non-split-dosage group). Independently of PEG volumes, the split-dosage regimen produced markedly superior cleansing results over the same-day method (good/excellent 327/435, 75.2% vs 186/433, 43.0%, P = .00001). Maximum cleansing was observed in colonoscopies performed within 8 hours from the last fluid intake versus over 8 hours from the last fluid intake (P < .001). The degree of bowel cleansing affected both cecal intubation (failed intubation 11.7% with fair/poor preparation vs 1.2% with good/excellent preparation, P = .00001) and polyp detection rates (12.2% with fair/poor vs 24.6% with good/excellent preparation, P = .001). Aborted procedures were significantly more frequent in the non-split-dosage arm (21.2% vs 6.9%, odds ratio [OR] 3.60 [2.29-5.77], P < .0001). Independent predictors of poor bowel cleansing were male sex (OR 1.45 [1.08-1.96], P = .014) and a non-split-dosage bowel preparation schedule (OR 2.08 [1.89-2.37], P = .0001). CONCLUSION Low-volume PEG plus ascorbic acid is as effective as high-volume PEG-electrolyte solution but has superior palatability. A split-dosage schedule is the most effective bowel cleansing method. Colonoscopy should be performed within 8 hours of the last fluid intake.
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Affiliation(s)
- Riccardo Marmo
- Division of Gastroenterology, Curto Hospital, Polla, Italy.
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