Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction.
Lin Otto S
Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continue to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals (monitored anesthesia care) or whether properly trained non-anesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation. The deployment of non-anesthesia administered propofol sedation for low-risk procedures allows for optimal allocation of scarce anesthesia resources, which can be more appropriately used for more complex cases. This can address some of the current shortages in anesthesia provider supply, and can potentially reduce overall health care costs without sacrificing sedation quality. This review will discuss efficacy, safety, efficiency, cost and satisfaction issues with various modes of sedation for non-advanced, non-emergent endoscopic procedures, mainly esophagogastroduodenoscopy and colonoscopy.
Smartphone Application to Reinforce Education Increases High-Quality Preparation for Colorectal Cancer Screening Colonoscopies in a Randomized Trial.
Walter Benjamin,Frank Rena,Ludwig Leopold,Dikopoulos Nektarios,Mayr Martina,Neu Bruno,Mayer Benjamin,Hann Alexander,Meier Benjamin,Caca Karel,Seufferlein Thomas,Meining Alexander
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
BACKGROUND & AIMS:Sufficient bowel preparation is crucial for successful screening and surveillance colonoscopy. However, rates of inadequate preparation are still high. We investigated the effects of reinforced patient education using a smartphone application software (APP) for colonoscopy preparation in participants in a CRC screening program. METHODS:We performed a prospective, endoscopist-blinded study of 500 patients undergoing split-dose bowel preparation for CRC screening or surveillance colonoscopies at multiple centers in Germany, from November 2017 through January 2019. Participants (n = 500) were given oral and written instructions during their initial appointment and then randomly assigned (1:1) to groups that received reinforced education starting 3 days before the colonoscopy (APP group) or no further education (controls). The primary outcome was quality of bowel preparation according to the Boston bowel preparation scale. Secondary outcomes included polyp and adenoma detection rates, compliance with low-fiber diet, split-dose laxative intake, perceived discomfort from the preparation procedure. RESULTS:The mean Boston bowel preparation scale score was significantly higher in the APP-group (7.6 ± 0.1) than in the control group (6.7 ± 0.1) (P < .0001). The percentage of patients with insufficient bowel preparation was significantly lower in the APP group (8%) than in the control group (17%) (P = .0023). The adenoma detection rate was significantly higher in the APP group (35% vs 27% in controls) (P = .0324). Use of the APP was accompanied by a lower level of non-compliance with correct laxative intake (P =.0080) and diet instructions (P = .0089). The APP group reported a lower level of discomfort during preparation (P < .0001). CONCLUSIONS:In a randomized trial, reinforcing patient education with a smartphone application optimized bowel preparation in the 3 days before colonoscopy, increasing bowel cleanliness, adenoma detection, and compliance in patients undergoing CRC screening or surveillance. ClinicalTrials.gov no: NCT03290157.
Pilot validation of the Boston Bowel Preparation Scale in China.
Gao Yan,Lin Ju-Sheng,Zhang Hou-De,Lin Mu-Xian,Cheng Chun-Sheng,Wu Sheng-Zhou
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
BACKGROUND AND AIM:The Boston Bowel Preparation Scale (BBPS) is a novel bowel cleanliness rating scale that has undergone validation at Boston University Medical Center, Boston, MA, USA. Thus far, there is no standard recognized bowel preparation scale in China. The aim of the present study was to analyze the reliability and validity of the BBPS for the assessment of bowel preparation quality (BPQ) in China. METHODS:A group of 49 participants from several hospitals in Guangdong province viewed a video demonstration of BBPS provided by Boston Medical Center and participated in a continuing education seminar. Inter-observer reliability was assessed for three testing colonoscopies in the video. Three months later, 13 of the participants repeated the test, and intra-observer reliability was assessed. The BBPS was then applied prospectively in 1012 screening colonoscopies and BBPS scores were compared with polyp-detection rate. Intraclass correlation coefficients (ICC) and weighted Kappa values assessed inter- and intra-rater reliability, respectively. The association of BBPS scores with polyp-detection rates was calculated by χ(2) tests. RESULTS:The inter-observer ICC of BBPS scores was 0.987 (95% CI, 0.949-1.0). The weighted Kappa for BBPS scores was 0.671 (95%CI, 0.507-0.841). For 1012 screening colonoscopies, the mean BBPS score was 6.9 ± 1.8. BBPS scores ≥ 5 were associated with a higher polyp-detection rate (35%) than scores < 5 (18%) (P < 0.05). CONCLUSION:The BBPS is a valid and reliable measure of BPQ, and this validity and reliability was maintained for Chinese physicians taught via video.
2 L versus 4 L of PEG3350 + electrolytes for outpatient colonic preparation: a randomized, controlled trial.
Brahmania Mayur,Ou George,Bressler Brian,Ko Hin Kin,Lam Eric,Telford Jennifer,Enns Robert
BACKGROUND:Low-volume bowel preparations are ideal to ensure patient compliance, thus enabling high-quality examinations to be achieved. OBJECTIVES:To examine the bowel-cleansing efficacy and patient tolerability of split-dose 2 L PEG3350 + electrolytes (PEG3350e) with 15 mg bisacodyl versus split-dose 4 L PEG3350e. DESIGN:Single-blinded, noninferiority, randomized, controlled trial. SETTING:Single site, university-affiliated tertiary care center. PATIENTS:A total of 325 consecutive patients undergoing elective outpatient colonoscopy. INTERVENTION:2 L of PEG3350e with 15 mg bisacodyl versus 4 L of PEG3350e, both given in a split-dose fashion. MAIN OUTCOME MEASUREMENTS:Efficacy and tolerability of a split dose of 2 L of PEG3350e with 15 mg bisacodyl. Efficacy was assessed by using the Boston Bowel Preparation Scale and Ottawa Bowel Preparation Scale. Patient satisfaction and tolerability were assessed by using a short survey. RESULTS:A total of 325 patients were included in the intention-to-treat analysis (51% male) with a mean ± standard deviation age of 56 ± 11.2 years. No statistically significant difference in cleanliness was found by using the Boston Bowel Preparation Scale (intention-to-treat, P = .381; per-protocol, P = .387) and the Ottawa Bowel Preparation Scale (intention-to-treat, P = .285; per-protocol, P = .334). Participants receiving 2 L of PEG3350e found the preparation easy to consume and were willing to repeat the procedure more often than the 4-L group (P < .001). LIMITATIONS:Single-center study looking at outpatient colonoscopies; unable to comment on adenoma detection rate. CONCLUSIONS:Bowel-cleansing efficacy was similar in both the 2-L and 4-L PEG3350e groups; however, patient tolerability and willingness to repeat preparation were statistically greater with the 2 L of PEG3350e with 15 mg bisacodyl regimen.
The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research.
Lai Edwin J,Calderwood Audrey H,Doros Gheorghe,Fix Oren K,Jacobson Brian C
BACKGROUND:Few bowel-preparation rating scales have been validated. Most scales were intended for comparing oral purgatives and fail to account for washing and/or suctioning by the endoscopist. This limits their utility in studies of colonoscopy outcomes, such as polyp-detection rates. OBJECTIVE:To develop a valid and reliable scale for use in colonoscopy outcomes research. SETTING:Academic medical center. METHODS:We developed the Boston bowel preparation scale (BBPS), a 10-point scale that assesses bowel preparation after all cleansing maneuvers are completed by the endoscopist. We assessed interobserver and intraobserver reliability by using video footage of colonoscopies viewed on 2 separate occasions by 22 clinicians. We then applied the BBPS prospectively during screening colonoscopies and compared BBPS scores with clinically meaningful outcomes, including polyp-detection rates and procedure times. RESULTS:The intraclass correlation coefficient (a measure of interobserver reliability) for BBPS scores was 0.74. The weighted kappa (a measure of intraobserver reliability) for scores was 0.77 (95% CI, 0.66-0.87). During 633 screening colonoscopies, the mean (SD) BBPS score was 6.0 +/- 1.6. Higher BBPS scores (> or =5 vs <5) were associated with a higher polyp-detection rate (40% vs 24%, P < .02). BBPS scores were inversely correlated with colonoscope insertion (r = -0.16, P < .003) and withdrawal (r = -0.23, P < .001) times. LIMITATIONS:Single-center study. CONCLUSIONS:The BBPS is a valid and reliable measure of bowel preparation. It may be well suited to colonoscopy outcomes research because it reflects the colon's cleanliness during the inspection phase of the procedure.
The advantage of polyethylene glycol electrolyte solution combined with lactulose in patients with long interval preparation-to-colonoscopy.
Yuanchao Hu,Xueping Li,Tao Lin,Jianping Niu,Man Mi
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology
BACKGROUND/AIMS:The main aim of the present study was to assess the efficacy of polyethylene glycol electrolyte (PEG) solution combined with lactulose in bowel preparation to find a new method for colonoscopy preparation to improve the quality of colonoscopy in patients with long interval preparation-to-colonoscopy (P-C). MATERIALS AND METHODS:A prospective, randomized, endoscopist-blinded and placebo-controlled study was conducted. Three hundred sixty patients who were scheduled for colonoscopy were enrolled in the study. They were randomly divided into the PEG-lactulose group and the PEG-placebo group with 180 patients per arm. Two of the most common methods for estimating the quality of bowel preparation were the use of the Boston Bowel Preparation Scale and the measurement of the Bubble Scale and adenoma detection rate (ADR) as a secondary outcome of observation. RESULTS:The PEG-lactulose group had a significant improvement in the quality of bowel preparation compared with the PEG-placebo group including colon cleanliness in interval P-C at 8 and 9 h (p<0.05) and bubble elimination in interval P-C at 5, 6, 7, 8, and 9 h (p<0.05). Compared with the PEG-placebo group, the ADR (23.3% vs. 15.0%, p<0.05) and the size (≤5 mm) of the adenoma (45.2% vs. 18.5%, p<0.05) increased in the PEG-lactulose group, and there were significant differences between the two groups. CONCLUSION:PEG solution combined with lactulose can improve the quality of colonoscopy in patients with long interval P-C to allow the patients to select more flexible colonoscopy time. It is worth further popularizing in clinical practice.
Same-day Versus Split-dose Bowel Preparation Before Colonoscopy: A Meta-analysis.
Cheng Yuan-Lung,Huang Kuang-Wei,Liao Wei-Chih,Luo Jiing-Chyuan,Lan Keng-Hsin,Su Chien-Wei,Wang Yuan-Jen,Hou Ming-Chih
Journal of clinical gastroenterology
BACKGROUND:Split-dose regimens (SpDs) were recommended as a first choice for bowel preparation, whereas same-day regimens (SaDs) were recommended as an alternative; however, randomized trials compared them with mixed results. The meta-analysis was aimed at clarifying efficacy level between the 2 regimens. MATERIALS AND METHODS:We used MEDLINE/PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and Web of Science to identify randomized trials published from 1990 to 2016, comparing SaDs to SpDs in adults. The pooled odds ratios (ORs) were calculated for preparation quality, cecal intubation rate (CIR), adenoma detection rate (ADR), and any other adverse effects. RESULTS:Fourteen trials were included. The proportion of individuals receiving SaDs and SpDs with adequate preparation in the pooled analysis were 79.4% and 81.7%, respectively, with no significant difference [OR=0.92; 95% confidence interval (CI), 0.62-1.36] in 11 trials. Subgroup analysis revealed that the odds of adequate preparation for SaDs with bisacodyl were 2.45 times that for SpDs without bisacodyl (95% CI, 1.45-4.51, in favor of SaDs with bisacodyl). Subjects received SaDs experienced better sleep. CONCLUSIONS:SaDs were comparable with SpDs in terms of bowel cleanliness, CIR, and ADR, and could also outperform SpDs in preparation quality with bisacodyl. SaDs also offered better sleep the previous night than SpDs did, which suggests that SaDs might serve as a superior alternative to SpDs. The heterogenous regimens and measurements likely account for the low rates of optimal bowl preparations in both arms. Further studies are needed to validate these results and determine the optimal purgatives and dosages.
Efficacy of single- versus split-dose polyethylene glycol electrolyte solution for morning colonoscopy: A randomized controlled study.
Shan Jing,Yang Mei,Ran Wenbin,Xi Weidong,Jiang Lin,Sun Xiaobin
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association
Background:Split-dose (SPD) regimen has been proved more effective than a single-dose (SID) regimen for various drug preparations; however, limited data have focused on morning colonoscopy. We implemented this study to compare the bowel cleanliness and tolerability of a same-day SID versus SPD 2 L polyethylene glycol electrolyte solution (PEG) for morning colonoscopy. Methods:Patients undergoing morning colonoscopy were randomized into two groups, SID or SPD. In the SID group, patients had to complete 2 L PEG between 4 and 6 am on the day of colonoscopy. In the SPD group, patients had to complete 1 L PEG between 8 and 9 pm on the day before followed by another 1 L PEG between 5 and 6 am on the day of colonoscopy. Colonoscopy was performed between 8 and 12 am under anesthesia. Investigators and endoscopists were blinded to the allocation. The primary end point was the effectiveness of bowel cleansing according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes were polyp detection rate, compliance, tolerability, and patient satisfaction. Results:Overall, there were 147 and 148 patients in the SID and SPD group, respectively. The SPD group had a better quality of bowel preparation than the SID group with a total BBPS score of 7.25 ± 1.53 versus 6.71 ± 1.65 (P = 0.005). No difference in the polyp detection rate was noted, although more polyps were detected in the SPD group. More patients felt acceptable with the bowel preparation regimen in the SPD group compared to the SID group (76% vs. 65%, P = 0.03). The adverse events were more commonly observed in the SID group, presented as nausea and vomiting. Conclusion:For morning colonoscopy, split-dose 2 L PEG is superior to single-dose 2 L PEG by improved bowel preparation, better tolerability, and patient satisfaction.
Split-Dose Bowel Preparation Reduces the Need for Early Repeat Colonoscopy Without Improving Adenoma Detection Rate.
Wang Li,Sprung Brandon S,DeCross Arthur J,Marino Danielle
Digestive diseases and sciences
BACKGROUND AND AIMS:Split-dose bowel preparation is associated with improved mucosal visualization and patient tolerance, becoming a standard of care. However, quality measures data associated with this preparation are limited. At our academic tertiary-care facility, we aim to study the effect of changing from single- to split-dose preparation on colonoscopy quality measures. METHODS:A retrospective cohort study with quality indicators was conducted using electronic medical record data. Cases were identified via ICD9 code V76.51, "Special screening for malignant neoplasms of colon." Single-dose preparation data was collected from 9/1/13 to 8/31/14. Split-dose preparation was implemented 11/2014, and data were collected from 1/1/15 to 8/31/15. RESULTS:A total of 1602 colonoscopies in the single-dose group and 1061 colonoscopies in the split-dose group were analyzed. The Boston Bowel Preparation Scale was significantly improved in the split-dose group 8.64 ± SD 1.25 versus 8.25 ± SD 1.61, p < 0.001. There was no significant difference in adenoma detection rate 40.7% (95% CI 37.8-43.7%) versus 40.5% (95% CI 38.1-42.9%), p = 0.92; however, the rate for recommending an early repeat examination due to an inadequate bowel preparation was significantly decreased to 3.9% (95% CI 2.7-5.0%) versus 8.9% (95% CI 1.52-2.97%), p < 0.001. CONCLUSION:While split-dose preparation significantly improves overall bowel cleanliness, there is no significant adenoma detection rate improvement with high baseline rate, suggesting a threshold which may not improve with enhanced preparations. Split-dose preparation significantly reduces the frequency with which inadequate preparation prompts an early repeat examination, which has important clinical implications on performance, costs, and patient experience, providing further evidence supporting split-dose preparation use.
Estimated GFR Decline Following Sodium Phosphate Enemas Versus Polyethylene Glycol for Screening Colonoscopy: A Retrospective Cohort Study.
Schaefer Monica,Littrell Emily,Khan Amina,Patterson Mark E
American journal of kidney diseases : the official journal of the National Kidney Foundation
BACKGROUND:Associations between sodium phosphate enemas and nephropathy have raised concerns about the safety of use as part of a bowel-cleansing regimen administered prior to colonoscopies. The objectives of this analysis are to evaluate the impact of sodium phosphate enema versus polyethylene glycol powder for oral solution (PEG) use prior to colonoscopy screening on estimated glomerular filtration rate (eGFR) decline in Veterans Affairs (VA) patients and identify other risk factors contributing to eGFR decline. STUDY DESIGN:Retrospective cohort study. SETTING & PARTICIPANTS:70,499 VA patients receiving sodium phosphate enemas (with or without PEG) or PEG alone prior to colonoscopy screenings. PREDICTOR:Use of either sodium phosphate or PEG. OUTCOMES:A 50% increase in serum creatinine level over a 15-month, over a 6-week, and between a 9- and 15-month period was used to define any, acute, or long-term eGFR decline, respectively. MEASUREMENTS:Multivariable logistic regressions estimated the likelihood of eGFR decline conditional on the use of sodium phosphate enemas versus PEG alone, controlling for potential confounders. RESULTS:A greater proportion of patients using sodium phosphate enemas versus PEG had any (P<0.001) or long-term (P=0.003) eGFR declines, whereas similar proportions had acute eGFR declines (P=0.9). In the adjusted analyses, use of sodium phosphate enemas (± PEG was associated with an increased likelihood of having any (OR, 1.3; 95% CI, 1.2-1.5) or long-term (OR, 1.4; 95% CI, 1.1-1.8) eGFR decline, but not acute eGFR decline (OR, 1.0; 95% CI, 0.6-1.7). Other risk factors for eGFR decline included diabetes and non-iron deficient anemia. LIMITATIONS:Unobserved heterogeneity due to volume depletion and potential selection bias due to higher-risk patients preferentially prescribed sodium phosphate enemas. CONCLUSIONS:Use of sodium phosphate enemas versus PEG alone prior to colonoscopy screening increases the risk for VA patients having long-term eGFR decline. Patients with non-iron deficient anemia are at particularly high risk for eGFR decline. These findings motivate the need to re-examine prescribing practices for sodium phosphate enemas as part of a bowel-cleansing regimen.
Application of Oral Lactulose in Combination With Polyethylene Glycol Electrolyte Powder for Colonoscopy Bowel Preparation in Patients With Constipation.
Lu Juan,Cao Qin,Wang Xiaochun,Pu Jianbin,Peng Xuelian
American journal of therapeutics
The aim of the study was to investigate the efficacy of combined application of lactulose oral solution and polyethylene glycol electrolyte powder compared with conventional method in preparing for colonoscopy bowel cleanliness in patients with constipation. Ninety patients, who had constipation and needed to have colonoscopy, were divided into study group and control group with 45 cases in each group, respectively. One day before the colonoscopy, patients in the experimental group were given lactulose oral solution and polyethylene glycol electrolyte powder, whereas the patients in the control group were given oral polyethylene glycol electrolyte powder only. The following parameters were then obtained: time of the first defecation (duration of the time from taking the drugs to the first bowel movement), defecation frequency, completion of bowel cleaning (duration from the first bowel movement to the stool becoming clear), and adverse reaction. Cleansing effect in the study group bowel preparation was significantly better than that in the control group (P < 0.05). Specifically, time of the first defecation and completion of bowel cleaning were statistically shorter in the study group than those in the control group (P < 0.05), and defecation frequency was significantly higher in the study group than that in the control group (P < 0.05). Incidence of adverse reaction, however, was not significantly different between the 2 groups (P > 0.05). Combined application of lactulose oral solution and polyethylene glycol electrolyte powder is superior to the conventional method of polyethylene glycol electrolyte powder alone for colonoscopy bowel preparation in patients with constipation. Therefore, combined clinical application of the 2 compounds is strongly recommended for colonoscopy bowel preparation in patients with constipation.
Colonoscopy--how difficult, how painful?
Hull T,Church J M
Colonoscopy is sometimes painful for the patient and often difficult for the endoscopist, but it is hard to predict how difficult or painful the examination will be. The purpose of this study was to identify factors that influence difficulty and pain during colonoscopy. Some 1,284 consecutive patients undergoing office colonoscopy by three endoscopists were prospectively studied. A standard questionnaire was completed by the nursing staff, who assessed the degree of difficulty and pain associated with each exam on a four-point scale. There were 682 men and 551 women (sex not recorded in 51). There was no pain in 27%, mild pain in 39%, moderate pain in 25%, and severe pain in 9%. There was no difficulty in 25%, mild difficulty in 33%, moderate difficulty in 28%, and severe difficulty in 14%. Colonoscopy was significantly easier (P < 0.001, chi square) and less painful (P < 0.001, chi square) in patients after sigmoidectomy. It was more painful after hysterectomy (P < 0.05, chi square) and more difficult and painful in women than in men (P < 0.01, chi square). There were significant differences between endoscopists in the assessment of pain associated with colonoscopy. Most colonoscopies are associated with little or no pain (66%) and are easy or only mildly difficult to perform (58%). Patients who have had sigmoid resection are especially easy and painless to examine while women, especially after hysterectomy, are at higher risk of having a painful experience. Colonoscopy technique can influence the amount of pain experienced by the patient.
Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy.
Rudner Robert,Jalowiecki Przemyslaw,Kawecki Piotr,Gonciarz Maciej,Mularczyk Aldona,Petelenz Michal
BACKGROUND:This study tested the hypothesis that, for colonoscopy, analgesia/sedation with remifentanil and propofol might be more effective compared with anesthesia by intravenous administration of midazolam, fentanyl, and propofol. METHODS:In a prospective, randomized trial, 100 adult patients received either conscious analgesia/sedation (Sedation group) or total intravenous anesthesia (TIVA group). Analgesia/sedation was achieved by infusion of remifentanil (0.20 to 0.25 microg/kg/min) and propofol in titrated doses. TIVA was induced by intravenous administration of fentanyl (2 microg/kg), midazolam (0.05 mg/kg) and propofol (dosage titrated). Cardiorespiratory parameters and bispectral index were monitored and recorded. The quality of the analgesia was assessed with a Numerical Pain Rating Scale (NRS); recovery level and return of psychomotor efficiency were evaluated with, respectively, the Aldrete scale and a Modified Post Anesthesia Discharge Scoring (MPADS) system. RESULTS:Both groups of 50 patients were comparable with respect to demographic data, initial parameters, and duration of colonoscopy. All patients in the TIVA group found the colonoscopy painless (NRS score 0). In the Sedation group, the average pain intensity score was 0.4 (0.8). There was a marked difference between the Sedation and TIVA groups with respect to the time from the end of the procedure until the maximum MPADS score was reached: respectively, -6.9 (4.0) versus 25.7 (8.4) minutes (p < 0.001). In the TIVA group, changes in mean arterial pressure and heart rate and signs of respiratory depression were significant (p < 0.05). CONCLUSIONS:Combined administration of remifentanil and propofol for colonoscopy provides sufficient analgesia, satisfactory hemodynamic stability, minor respiratory depression, and rapid recovery, and allows patients to be discharged approximately 15 minutes after the procedure.
Safety and efficacy of propofol alone or in combination with other agents for sedation of patients undergoing colonoscopy: an updated meta-analysis.
Zhang K,Xu H,Li H-T
European review for medical and pharmacological sciences
The aim of this meta-analysis was to assess the efficacy and safety of propofol sedation for colonoscopy in comparison with traditional sedative agents. We performed a systematic search of PubMed, Embase, Scopus, Web of Science CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases to identify eligible randomized controlled trials (RCTs) published before November 2019, and compared the effect of traditional sedative agents (TA) with the effect of propofol/propofol combined with TAs for routine colonoscopy. We included 22 eligible trials in our analysis, with a total of 2575 participants. We found strong associations between propofol use and short recovery (SMD MD, -1.15 [-1.55, -0.75], p<0.00001), procedure duration (SMD -0.28 [-0.55, -0.02], p<0.05), discharge times (SMD= -0.71 [-1.06, -0.36], p<0.0001), and sedation scores (SMD 1.29 [0.36, 2.22], p<0.05). Propofol in combination with traditional agents led to a significant decrease in discharge time compared with the discharge times of traditional sedatives alone (SMD=-0.69 [-1.07, -0.31], p<0.0004). The effects of propofol on cecal intubation rates, and occurrences of hypotension and apnea were similar to those of TAs. Our results suggest that propofol can be used as a safe alternative to TAs, and can significantly shorten procedure duration, recovery and discharge times, and improve sedation depth.
Combination of propofol and dezocine to improve safety and efficacy of anesthesia for gastroscopy and colonoscopy in adults: A randomized, double-blind, controlled trial.
Li Xue-Ting,Ma Chao-Qun,Qi Si-Hua,Zhang Li-Min
World journal of clinical cases
BACKGROUND:Gastroscopy and colonoscopy are important and common endoscopic methods for the diagnosis and treatment of gastrointestinal and colorectal diseases. However, endoscopy is usually associated with adverse reactions such as nervousness, nausea, vomiting, choking cough, and pain. Severe discomfort, such as vomiting, coughing, or body movement, may lead to aggravation of a pre-existing condition or even interruption of examination or treatment, especially in some critically ill patients with physiological dysfunction (., cardiovascular or respiratory disease). The optimal methods for inducing analgesia and sedation in endoscopy are areas of ongoing debate; nevertheless, determining an appropriate regimen of sedation and analgesia is important. AIM:To evaluate the effects of propofol combined with dezocine, sufentanil, or fentanyl in painless gastroscopy and colonoscopy. METHODS:Four hundred patients were randomly assigned to one of four groups for anesthesia: intravenous dezocine, sufentanil, fentanyl, or saline. Propofol was administered intravenously for induction and maintenance of anesthesia. RESULTS:The dosage of propofol in the dezocine group was significantly lower than those in other groups ( < 0.01). Bispectral index and Steward score (0-6 points, an unresponsive, immobile patient whose airway requires maintenance to a fully recovered patient) after eye opening in the dezocine group were significantly higher than those in other groups ( < 0.01). Awakening time and postoperative pain score (0-10 points, no pain to unbearable pain) in the dezocine group were significantly lower than those in other groups ( < 0.01). Mean arterial pressure and pulse oxygen saturation in the dezocine group were significantly more stable at various time points (before dosing, disappearance of eyelash reflex, and wakeup) than those in other groups ( < 0.01). The rates of hypopnea, jaw thrust, body movements, and usage of vasoactive drugs in the dezocine group were significantly lower than those in other groups ( < 0.01). Additionally, the rates of reflex coughing, nausea, and vomiting were not statistically different between the four groups ( > 0.05). CONCLUSION:The combination of propofol and dezocine can decrease propofol dosage, reduce the risk for the development of inhibitory effects on the respiratory and cardiovascular systems, increase analgesic effect, decrease body movement, shorten awakening time, and improve awakening quality.
[Bowel preparation for colonoscopy: comparative study using Boston Bowel Preparation Scale].
Coghlan Eduardo,Laferrere Luis,Ayunta Horacio,Martínez María Lourdes Posadas,Topor Jorge Javier,Nadales Angel,del Solar Carlos González
Acta gastroenterologica Latinoamericana
BACKGROUND:Most comparative studies on different preparations for colonic cleanliness use unvalidated scales with terms as "excellent," "good," "fair," and "poor" which lack standardized definitions. The Boston Bowel Preparation Scale (BBPS) is a valid and simple measure of bowel preparation. OBJECTIVE:To compare three different bowel preparations [polyethylenglycol (PEG), sodium phosphates, and PEG + bisacodyl tablets] using BBPS. MATERIAL AND METHODS:Patients undergoing screening colonoscopies were included during a period of 6 months. Every patient was scored according to BBPS. RESULTS:Six endoscopists prospectively enrolled 374 patients (200 female and 174 male, median age 56.9 years old). Physicians chose the preparation method, and in spite of not being a randomized trial, numbers in each group allowed statistical analysis: PEG 116patients (31%), sodium phosphates 212 (56.7%) and bisacodyl 46 (12.3%). There was statistical difference between the three preparations in favor of the 4 litre solution of PEG, with a median score of 7, towards sodium phosphates and bisacodyl, with median scores of 6 (P < 0.001). Depending on bowel preparation, there were positive polyp findings in 40% of colonoscopies with PEG, 26% with sodium phosphates and 22% with bisacodyl (P = 0.01). Afternoon procedures had better preparation scores than morning procedures, 7 and 6, respectively (P < 0.001). In the afternoon colonoscopies, there were no statisticaIly significant differences between the preparations (P = 0.12) or polyp findings (P = 0.13). In the morning shift, PEG prepared patients had better scores (score of 6) when compared to sodium phosphate (score of 5) and bisacodyl (score of 6) (P = 0.001). We also noticed that the shorter the time interval between the last intake of the preparation and the procedure, the better the score. CONCLUSIONS:Bowel preparations for colonoscopy with PEG are significantly better than sodium phosphate and bisacodyl preparations, with higher BBPS scores and polyp detection rates.
A Korean experience of the use of Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research.
Kim Eun-Jin,Park Young-Il,Kim You-Sun,Park Won-Wo,Kwon Sun-Ok,Park Kyoung-Sik,Kwak Cheol-Hun,Kim Jin-Nam,Moon Jeong-Seop
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association
BACKGROUND/AIMS:Few bowel preparation scales have been validated. The Boston Bowel Preparation Scale (BBPS) is a novel bowel preparation scale in western countries. We validated the BBPS in Korean patients and assessed the relationship between the colon polyp detection rate and BBPS score. PATIENTS AND METHODS:This study was a prospective, single-center trial. The BBPS is a 10-point scale that assesses bowel preparation after the completion of all cleansing maneuvers. We assessed three segment scores (the right side, transverse section, and left side) and total BBPS scores during screening colonoscopy. In addition, we compared the BBPS scores with clinically meaningful outcomes such as the polyp detection rate and colonoscope withdrawal times. RESULTS:We enrolled 482 screening colonoscopies between January 2011 and January 2012. The mean (± standard deviation [SD]) BBPS score was 8.1 ± 1.1. Higher BBPS scores (≥8 vs <8) were associated with a higher polyp detection rate (44.9% vs. 33.0%, P = 0.042). The BBPS scores were inversely correlated with colonoscope withdrawal times (r = -0.167, P < 0.001). CONCLUSIONS:The BBPS is a valid and reliable measure for assessing bowel preparation during colonoscopy in Korean patients. The polyp detection rate is higher in patients with higher BBPS scores than in those with lower BBPS scores during a colonoscopic procedure.
Efficacy and tolerability of low-volume (2 L) versus single- (4 L) versus split-dose (2 L + 2 L) polyethylene glycol bowel preparation for colonoscopy: randomized clinical trial.
Téllez-Ávila Félix I,Murcio-Pérez Enrique,Saúl Angela,Herrera-Gómez Salvador,Valdovinos-Andraca Francisco,Acosta-Nava Victor,Barreto Rafael,Elizondo-Rivera Javier
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
BACKGROUND AND AIM:To compare the efficacy and tolerability of a low-volume (2-L) polyethylene glycol (PEG) regimen for colonoscopy compared to single (4-L) or split-dose (2-L + 2-L) regimens. METHODS:In-hospital patients who were candidates for colonoscopy were randomly assigned to: group 1 single-dose (PEG 4 L the day before the study, n = 60); group 2: split-dose (2 L the day before and 2 L on the day of the procedure, n = 61); and group 3: low-volume 2-L PEG solution (the day of the procedure, n = 59). A blinded evaluation of the quality of colonic preparation was assessed by the Boston bowel preparation scale. RESULTS:Satisfactory bowel preparation of the right colon was more frequently reported for group 3 than for group 1 (70% vs 53%, P = 0.045), in the transverse colon it was 82% versus 69% (P = 0.032), and on the left side of the colon it was 80% versus 67.7% (P = 0.028). Compared to group 2, satisfactory bowel preparation in group 3 was similar in the transverse colon and left colon. Nausea, vomiting, and abdominal discomfort were less frequent in patients of group 3. Patients in group 3 had fewer sleep disorders and fewer hours of sleep loss compared to patients in the other groups. CONCLUSIONS:Preparation with 2 L caused less abdominal discomfort and fewer sleep disorders. The split dose had a better quality of preparation in the right colon. Both preparations were clearly better than the 4-L preparation.
Controlled Dietary Restriction With a Prepackaged Low-Residue Diet Before Colonoscopy Offers Better-Quality Bowel Cleansing and Allows the Use of a Smaller Volume of Purgatives: A Randomized Multicenter Trial.
Chou Chu-Kuang,Chang Chi-Yang,Chang Chun-Chao,Chang Li-Chun,Hsu Wen-Feng,Chen Chi-Yi,Wang Hsiu-Po,Chiu Han-Mo
Diseases of the colon and rectum
BACKGROUND:Bowel preparation is burdensome, and less-demanding preparation procedures are needed. Few studies have investigated the effects of low-residue diet and prepackaged low-residue diet in combination with low-volume polyethylene glycol-electrolyte lavage solution during colonoscopy preparation. OBJECTIVE:We compared self-prepared low-residue diets with prepackaged low-residue diets in combination with low-volume polyethylene glycol. DESIGN:This was a single-blinded, 3-arm, multicenter, randomized controlled trial. SETTING:Colonoscopies were conducted in outpatient settings at 3 centers in Taiwan. PATIENTS:The study included 180 patients (age range, 20-75 years) who were scheduled for colonoscopy. INTERVENTIONS:Three groups were compared: group A included self-prepared, 1-day, low-residue diets with a same-day 2.0-L single-dose of polyethylene glycol; group B included prepackaged low-residue diets plus 2.0 L of polyethylene glycol; and group C included prepackaged low-residue diets plus 1.5 L of polyethylene glycol. MAIN OUTCOME MEASURES:The outcome measures were adherence, bowel-cleansing level, and patient satisfaction. RESULTS:One third of the subjects in group A, but none in the prepackaged low-residue diets groups, violated the dietary restrictions. The proportion of right-segment preparation failure was 15.0%, 1.7%, and 6.7% (p = 0.025). Accordingly, treatment B was superior to A (p = 0.008). Among subjects violating the low-residue diets guideline, the right-segment preparation failure rate was 25%. According to a multivariate analysis, low-residue diet compliance (adjusted OR = 6.55 (95% CI, 1.83-23.43)) and BMI were predictors of right-sided preparation adequacy, but the volume of polyethylene glycol ingested was not a predictor. Compared with group A, a greater proportion of subjects in groups B and C reported satisfaction. LIMITATIONS:Patients with high BMI and severe constipation were excluded from this study. This study included only an Asian population. CONCLUSIONS:The prepackaged low-residue diet provides excellent adherence, better bowel cleansing, and a better experience than a self-prepared low-residue diet. With good dietary compliance, 1.5 L of polyethylene glycol provides effective preparation.
Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy.
Chokshi Reena V,Hovis Christine E,Hollander Thomas,Early Dayna S,Wang Jean S
BACKGROUND:The prevalence of missed polyps in patients with inadequate bowel preparation on screening colonoscopy is unknown. OBJECTIVE:To determine the prevalence of missed adenomas in average-risk patients presenting for screening colonoscopy who are found to have inadequate bowel preparation. DESIGN:Retrospective chart review. Endoscopy and pathology reports were examined to determine the characteristics of polyps. Data from repeat colonoscopies were collected through 2010. SETTING:Outpatient endoscopy center at an academic medical center. PATIENTS:This study involved patients who underwent outpatient average-risk screening colonoscopy between 2004 and 2009 documented to have inadequate bowel preparation and who had colonoscopy to the cecum. MAIN OUTCOME MEASUREMENTS:Initial adenoma detection rate and adenoma detection rate on follow-up examination. RESULTS:Inadequate bowel preparation was reported on 373 patients, with an initial adenoma detection rate of 25.7%. Of 133 patients who underwent repeat colonoscopy, 33.8% had at least 1 adenoma detected, and 18.0% had high-risk states detected (≥ 3 adenomas, 1 adenoma ≥ 1 cm, or any adenoma with villous features or high-grade dysplasia). Per-adenoma miss rate was 47.9%. Among patients with at least 1 adenoma on repeat colonoscopy, 31.1% had no polyps on initial colonoscopy; mean time between colonoscopies was 340 days. Among patients with high-risk states, 25.0% had no polyps seen on initial colonoscopy; mean time between colonoscopies was 271 days. LIMITATIONS:Retrospective design. CONCLUSION:Adenomas and high-risk lesions were frequently detected on repeat colonoscopy in patients with inadequate bowel preparation on initial screening colonoscopy, suggesting that these lesions were likely missed on initial colonoscopy.
Importance of reporting segmental bowel preparation scores during colonoscopy in clinical practice.
Jain Deepanshu,Momeni Mojdeh,Krishnaiah Mahesh,Anand Sury,Singhal Shashideep
World journal of gastroenterology
AIM:To evaluate the impact of reporting bowel preparation using Boston Bowel Preparation Scale (BBPS) in clinical practice. METHODS:The study was a prospective observational cohort study which enrolled subjects reporting for screening colonoscopy. All subjects received a gallon of polyethylene glycol as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Site and size of the polyps detected was recorded. Pathology reports were reviewed to determine advanced adenoma detection rates (AADR). Segmental AADR's were calculated and categorized based on the segmental BBPS to determine the differential impact of bowel prep on AADR. RESULTS:Three hundred and sixty subjects were enrolled in the study with a mean age of 59.2 years, 36.3% males and 63.8% females. Four subjects with incomplete colonoscopy due BBPS of 0 in any segment were excluded. Based on composite BBPS subjects were divided into 3 groups; Group-0 (poor bowel prep, BBPS 0-3) n = 26 (7.3%), Group-1 (Suboptimal bowel prep, BBPS 4-6) n = 121 (34%) and Group-2 (Adequate bowel prep, BBPS 7-9) n = 209 (58.7%). AADR showed a linear trend through Group-1 to 3; with an AADR of 3.8%, 14.8% and 16.7% respectively. Also seen was a linear increasing trend in segmental AADR with improvement in segmental BBPS. There was statistical significant difference between AADR among Group 0 and 2 (3.8% vs 16.7%, P < 0.05), Group 1 and 2 (14.8% vs 16.7%, P < 0.05) and Group 0 and 1 (3.8% vs 14.8%, P < 0.05). χ(2) method was used to compute P value for determining statistical significance. CONCLUSION:Segmental AADRs correlate with segmental BBPS. It is thus valuable to report segmental BBPS in colonoscopy reports in clinical practice.
A Comparison of Bowel Preparations for Colonoscopy in Constipated Adults.
Kunz Lisa,Gillespie Debra
Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates
Clinical practice shows that patients with constipation are more likely to have a poor bowel preparation for colonoscopy. Consequences of poor bowel preparation include missed lesions, increased complication rates, and higher costs. Research on preparing constipated patients for colonoscopy with Food and Drug Administration-approved medications is scarce. This study included 372 patients and compared the effectiveness of high-volume (4 L) polyethylene glycol solution (GoLYTELY) with low-volume (2 L) polyethylene glycol solution with ascorbate (MoviPrep) in constipated and nonconstipated adults. Patients were considered constipated if constipation was recently documented in their medical history, they self-reported constipation, and/or they met Rome III criteria for constipation. Quality of bowel preparation was rated with the Aronchick scale. Of the 372 patients enrolled, 65 (17.5%) were constipated. Among those with constipation, 26.1% (n = 17) had a bowel preparation rated fair or poor. There was no statistically significant difference in quality of bowel preparation between GoLYTELY and MoviPrep in chronically constipated adults (p = .27). This study concluded that patients with constipation were more likely than nonconstipated patients to have poor bowel preparation, and there was no statistically significant difference between GoLYTELY and MoviPrep. Further study is needed to determine an adequate preparation regimen.
Split-dose vs same-day reduced-volume polyethylene glycol electrolyte lavage solution for morning colonoscopy.
Chan Wah-Kheong,Azmi Najib,Mahadeva Sanjiv,Goh Khean-Lee
World journal of gastroenterology
AIM:To compare same-day whole-dose vs split-dose of 2-litre polyethylene glycol electrolyte lavage solution (PEG-ELS) plus bisacodyl for colon cleansing for morning colonoscopy. METHODS:Consecutive adult patients undergoing morning colonoscopy were allocated into two groups i.e., same-day whole-dose or split-dose of 2-litre PEG-ELS. Investigators and endoscopists were blinded to the allocation. All patients completed a questionnaire that was designed by Aronchick and colleagues to assess the tolerability of the bowel preparation regime used. In addition, patients answered an ordinal five-value Likert scale question on comfort level during bowel preparation. Endoscopists graded the quality of bowel preparation using the Boston bowel preparation scale (BBPS). In addition, endoscopists gave an overall grading of the quality of bowel preparation. Cecal intubation time, withdrawal time, total colonoscopy time, adenoma detection rate and number of adenomas detected for each patient were recorded. Sample size was calculated using an online calculator for binary outcome non-inferiority trial. Analyses was based upon intent-to-treat. Significance was assumed at P-value < 0.05. RESULTS:Data for 295 patients were analysed. Mean age was 62.0 ± 14.4 years old and consisted of 50.2 % male. There were 143 and 152 patients in the split-dose and whole-dose group, respectively. Split-dose was as good as whole-dose for quality of bowel preparation. The total BBPS score was as good in the split-dose group compared to the whole-dose group [6 (6-8) vs 6 (6-7), P = 0.038]. There was no difference in cecal intubation rate, cecal intubation time, withdrawal time, total colonoscopy time and adenoma detection rate. Median number of adenoma detected was marginally higher in the split-dose group [2 (1-3) vs 1 (1-2), P = 0.010]. Patients in the whole-dose group had more nausea (37.5% vs 25.2%, P = 0.023) and vomiting (16.4% vs 8.4%, P = 0.037), and were less likely to complete the bowel preparation (94.1% vs 99.3%, P = 0.020). Patients in the split-dose group were less likely to refuse the same bowel preparation regime (6.3% vs 13.8%, P = 0.033) and less likely to want to try another bowel preparation regime (53.8% vs 78.9%, P < 0.001). CONCLUSION:Splitting reduced-volume PEG-ELS for morning colonoscopy is as effective as taking the whole dose on the same morning but is better tolerated and preferred by patients.
Persisting changes of intestinal microbiota after bowel lavage and colonoscopy.
Drago Lorenzo,Toscano Marco,De Grandi Roberta,Casini Valentina,Pace Fabio
European journal of gastroenterology & hepatology
OBJECTIVE:An adequate bowel preparation is essential for a successful colonoscopy, but to date, only scarce information exists on the impact of the bowel cleansing on the gut microbiota, in particular, 1 month after the procedure. PATIENTS AND METHODS:Through 16S rDNA Ion Torrent profiling of fecal samples of 10 patients, we evaluated changes that occurred in the gut microbiota composition immediately after a 4 liter polyethylene glycol-based (SELG Esse) bowel lavage and 1 month thereafter. We studied the gut microbiota at the phylum, class, and family level. RESULTS:At the phyla level, we found a significant decrease in Firmicutes abundance and an increase in Proteobacteria abundance immediately after the colon cleansing and 1 month after the colonoscopy, whereas, at the class level, a significant increase in γ-Proteobacteria immediately after the colonoscopy was observed. Interestingly, 1 month after the endoscopic examination, this bacterial class was decreased 2.5-fold compared with samples before colonoscopy, as well as α-Proteobacteria. At the family level, a significant reduction in Lactobacillaceae and an increase in Enterobacteriaceae abundance were observed immediately after the colonoscopy, whereas 1 month after the bowel cleansing, these families were significantly lower compared with samples collected before the colonoscopy. Moreover, the abundance of Rikenellaceae and Eubacteriaceae has been observed to be significantly higher compared with samples collected before the bowel lavage. Finally, Streptococcaceae were increased 4.0-fold 1 month after the bowel lavage compared with fecal samples collected before the colonoscopy. CONCLUSION:We provide clear evidence that, in normal individuals, a high-volume polyethylene glycol bowel cleansing preparation has a long-lasting effect on the gut microbiota composition and homeostasis, in particular, with a decrease in the Lactobacillaceae abundance, a population of protective bacteria. Further studies are required to assess whether these changes have any metabolic, immunological, or clinical consequence.
Polyethylene Glycol Electrolyte Lavage Solution versus Colonic Hydrotherapy for Bowel Preparation before Colonoscopy: A Single Center, Randomized, and Controlled Study.
Cao Yan,Zhang Kai-Yuan,Li Jiao,Lu Hao,Xie Wan-Ling,Liao Sheng-Tao,Chen Dong-Feng,Zeng Deng-Feng,Lan Chun-Hui
Gastroenterology research and practice
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.
Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis.
Mahmood Sultan,Farooqui Samid M,Madhoun Mohammad F
European journal of gastroenterology & hepatology
The aim of this study was to investigate factors contributing to poor bowel preparation in patients undergoing colonoscopy procedures. We used a reproducible search strategy to identify studies, searching 10 medical databases, including PubMed, Ovid, Medline, and Cochrane Library Database for reports published between 2000 and 2016. Fully published studies, evaluating risk factors for inadequate bowel preparation, were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. Pooling was conducted with both fixed-effects and random-effects models; results were presented from the random effects model when heterogeneity was significant. Odds ratios (OR) estimates with 95% confidence interval were calculated. Heterogeneity was assessed by I statistics. Twenty-four studies with a total of 49 868 patients met the inclusion criteria. Age (OR: -1.20), male sex (OR: 0.85), inpatient status (OR: 0.57), diabetes mellitus (OR: 0.58), hypertension (OR: 0.58), cirrhosis (OR: 0.49), narcotic use (OR: 0.59), constipation (OR: 0.61), stroke (OR; 0.51), and tricyclic antidepressant (TCA) use (0.51), were associated with inadequate bowel preparation. In our sensitivity analysis comparing Western and Asian countries, we found that diabetes, cirrhosis, male sex, history of stroke and TCA use were stronger risk factors for inadequate bowel preparation in Western countries than in Asian countries. We also found that history of stroke, TCA use, and race were risk factors for inadequate bowel preparation in patients receiving conventional bowel preparation compared with those receiving split-dose bowel preparation. Multiple risk factors affect the quality of bowel preparation and specific risk factors can be intervened upon, in different populations, to optimize preparation.
Split-Dose Preparations Are Superior to Day-Before Bowel Cleansing Regimens: A Meta-analysis.
Martel Myriam,Barkun Alan N,Menard Charles,Restellini Sophie,Kherad Omar,Vanasse Alain
BACKGROUND & AIMS:There are different regimens of preparing the colon for colonoscopy, including polyethylene glycol (PEG), sodium phosphate, picosulfate, or oral sulfate solutions. We performed a meta-analysis to determine the efficacy of split-dose vs other colon preparation regimens, the optimal products for use, and the most effective preparation volumes. METHODS:We performed systematic searches of MEDLINE, EMBASE, Scopus, CENTRAL, and ISI Web of knowledge databases, from January 1980 to March 2014, for published results from randomized trials that assessed split-dose regimens vs day-before colonoscopy preparation. We excluded studies that included pediatric or hospitalized patients, or patients with inflammatory bowel disease. The primary outcome was efficacy of bowel cleansing. Secondary outcomes included side effects or complications, outcomes of procedures, patients' willingness to repeat the procedure, and the amount of time required for patients to resume daily activities. RESULTS:We identified 47 trials that fulfilled our inclusion criteria (n = 13,487 patients). Split-dose preparations provided significantly better colon cleansing than day-before preparations (odds ratio [OR], 2.51; 95% confidence interval, 1.86-3.39), as well as day-before preparations with PEG (OR, 2.60; 95% confidence interval, 1.46-4.63), sodium phosphate (OR, 9.34; 95% confidence interval, 2.12-41.11), or picosulfate (OR, 3.54; 95% confidence interval, 1.95-6.45). PEG split-dose preparations of 3 L or more yielded greater bowel cleanliness than lower-volume split-dose regimens (OR, 1.89; 95% confidence interval, 1.01-3.46), but only in intention-to-treat analysis. A higher proportion of patients were willing to repeat split-dose vs day-before cleansing (OR, 1.90; 95% confidence interval, 1.05-3.46), and low-volume split-dose preparations vs high-volume split-dose preparation (OR, 4.95; 95% confidence interval, 2.21-11.10). There were no differences between preparations in other secondary outcome measures. However, there was variation among studies in definitions and main and secondary outcomes. CONCLUSIONS:Based on meta-analysis, split-dose regimens increase the quality of colon cleansing and are preferred by patients compared with day-before preparations. Additional research is required to evaluate oral sulfate solution-based and PEG low-volume regimens further.
An Intraprocedural Endoscopic Cleansing Device for Achieving Adequate Colon Preparation in Poorly Prepped Patients.
Pérez Jiménez Javier,Diego Bermúdez Lucas,Gralnek Ian M,Martín Herrera Leopoldo,Libes Michael
Journal of clinical gastroenterology
BACKGROUND AND AIMS:An effective bowel preparation is essential for quality colonoscopy. Inadequate preparation results in missed lesions, need for earlier repeat procedures, prolonged colonoscopy duration, an increased likelihood of adverse events, reduced patient satisfaction, and increased costs. The MOTUS GI Pure-Vu System (Tirat Carmel, Israel) is an Food and Drug Administration-cleared device designed to improve visualization in an inadequately prepared colon by facilitating intraprocedural cleaning. We evaluated the efficacy, safety, and usability of the Pure-Vu System in cleansing poorly prepared colons in human subjects. METHODS:In total, 50 patients with poorly prepared colons undergoing colonoscopy were prospectively enrolled to evaluate the Pure-Vu System at 2 clinical sites [Spain (N=41) and Israel (N=9)]. Cleansing quality was measured using the Boston Bowel Preparation Score (BBPS). RESULTS:In total, 50 patients (64% male individuals), mean age 51.9±10.4 years, and mean body mass index of 26.6±3.1 were enrolled. The Pure-Vu System significantly increased the BBPS median score from 5.0 at baseline to 9.0 after the use of Pure-Vu (P<0.0001). Patients with an adequate cleansing level (BBPS≥2 in each colon segment) increased significantly from 31% (15/49) at baseline to 98% (48/49) after use of Pure-Vu (P<0.001). Cecal intubation was achieved in 48/49 (98%) patients. Colonoscopists were satisfied with the Pure-Vu System. No serious adverse events were reported. CONCLUSIONS:The Pure-Vu System was found to be safe, efficacious, and easy to use in cleansing inadequately prepared colons, enabling the colonoscopist to conduct a complete examination.
Adding pineapple juice to a polyethylene glycol-based bowel cleansing regime improved the quality of colon cleaning.
Altınbas Akif,Aktas Bora,Yılmaz Barıs,Ekiz Fuat,Deveci Murat,Basar Omer,Simsek Zahide,Coban Sahin,Tuna Yasar,Uyar Muhemmet Fatih,Yuksel Osman
Annals of nutrition & metabolism
BACKGROUND/AIMS:An unsuccessful colonoscopy procedure is often related to inadequate bowel cleansing. It is difficult for patients to finish the whole 4 liters of polyethylene glycol-electrolyte lavage (PEG-EL) because of its salty taste and the large quantity. Pineapple juice has been shown to be an effective agent in the dissolution of undigested food in the stomach. This study assessed the effectiveness of both 2 and 4 liters of PEG-EL in precolonoscopic bowel cleansing and the quality of colonoscopic cleaning by adding 1 liter of pineapple juice to a reduced-volume PEG-based regime. METHODS:The patients were chosen from those undergoing a colonoscopic procedure. A total of 126 patients were randomized into 3 groups receiving 3 different PEG-EL (Golytely®) regimes, i.e. 4 liters of PEG-EL (group 1, n = 44), 2 liters of PEG-EL (group 2, n = 39) or 2 liters of PEG-EL with 1 liter of pineapple juice (Dimes® 100%; group 3, n = 43). RESULTS:Both the 4- and 2-liter PEG-EL regimes resulted in similar bowel cleansing scores in all parts of the colonic segments. However, adding 1 liter of pineapple juice to the reduced-volume PEG-EL regime improved the quality of the cleansing on the right side of the colon and in the transverse colon. Adequate bowel cleansing was achieved in 68.1% of the patients in group 1, 63.9% in group 2 and 80% in group 3 (the lowest score in one of the segments). On the other hand, the tolerability of the regimes was similar in all 3 groups (p = 0.509). CONCLUSIONS:Reduced PEG-EL (2 rather than 4 liters) may be sufficient for precolonoscopic bowel cleansing in the Turkish population. Administration of pineapple juice in the reduced-dose preparation regime may improve the quality of the bowel cleaning.
Effect of mosapride citrate hydrate on the colon cleansing action of polyethylene glycol electrolyte lavage solution (PEG-ELS) in guinea pigs.
Mine Yukiko,Morikage Kazuo,Oku Seiko,Yoshikawa Takashi,Shimizu Isao,Yoshida Naoyuki
Journal of pharmacological sciences
Polyethylene glycol electrolyte lavage solution (PEG-ELS) is widely used for colon cleansing prior to colonoscopy and colonic surgery. It has recently been shown that coadministration of PEG-ELS and mosapride citrate hydrate (mosapride), a selective 5-HT(4)-receptor agonist, is clinically useful for barium enema examination as it allows adequate barium coating. However, there is no report showing that mosapride has beneficial effects on colon cleansing and its underlying mechanism in experimental animals. In the present study, we investigated the effects of mosapride on colonic transit and on the colon cleansing action of PEG-ELS in guinea pigs. Mosapride (10 - 20 mg/kg, i.g.) significantly enhanced colonic transit rate in guinea pigs. Although PEG-ELS alone showed adequate colon cleansing action, excess fluid remained in the colon. Coadministration of mosapride (20 mg/kg) and PEG-ELS, regardless of mosapride timing, reduced colonic content weight (dry residue and water amount) as compared to PEG-ELS alone. These findings suggest that mosapride enhances the colon cleansing action of PEG-ELS via an increase in colonic transit in guinea pigs, that is, it reduces not only fecal residue but also excessive fluid in the colonic lumen. It is therefore believed that coadministration of mosapride and PEG-ELS can allow better visualization in barium enema examination.
Colon hydrotherapy plus Traditional Chinese Medicine to treat non-alcoholic fatty liver disease: a pilot study.
Xiao Huanming,Jiang Junmin,Xie Yubao,Shi Meijie,Tian Guangjun,Zhao Pengtao,Zhang Chaozhen,Chen Huijun,Xu Chanyuan,Chi Xiaoling
Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan
OBJECTIVE:To demonstrate the potential to treat non-alcoholic fatty liver disease (NAFLD) with colon hydrotherapy (CHT) plus Traditional Chinese Medicine (TCM). METHODS:A total of 20 patients were enrolled into the study and received CHT with TCM for 2 weeks. Body mass index (BMI) and levels of serum triglycerides (TG) and total cholesterol (TC) were compared between pre-treatment and post-treatment. RESULTS:Two-week treatment with CHT plus TCM significantly lowered BMI and reduced blood lipids. BMI decreased from 29.5 4.3 to 25.4 1.0, while mean TG levels decreased by 0.70 mmol/L on average from baseline and mean TC levels decreased by 0.37 mmol/L. Forty-five percent of patients exhibited TC decreasing by more than 10% from baseline and 25% of patients exhibited TC decreasing by more than 20%. Sixty percent of patients exhibited TG decreasing by more than 20% and 20% of patients exhibited TG decreasing by more than 40%. However, high-density and low-density lipoprotein cholesterol levels did not change significantly after intervention. No serious adverse events were reported. CONCLUSION:Our findings suggest that CHT plus TCM to treat NAFLD is promising and it might be a new treatment strategy for management of NAFLD.