A Case of PICOLIGHT Powder Induced Thermal Injury of the Gastric Mucosa

Abstract

There are many reports about causes of corrosive agents such as acids and alkaline and occasionally hot food in either liquid or solid forms as causes of upper gastrointestinal mucosal injury. However, there have been no reports on bowel preparation solutions as a cause of upper gastrointestinal injury. We describe a case of bowel preparation solution (PICOLIGHT powder) induced thermal injury of the gastric mucosa with a review of the literature.

A Case of Thermal Esophageal Injury Induced by Sodium Picosulfate with Magnesium Citrate

“…The thermal injury occurred in the upper esophagus in our case, and in other cases it occurred in the esophagus and stomach [11, 14] and stomach [15]. Fortunately, all cases recovered with conservative management without complications such as esophageal stricture or perforation.…”

Esophageal Stricture Caused by the Ingestion of Undissolved Picosulfate Powder

“…Therefore, partially dissolved powder, ingestion of large volumes of water afterward, or early treatment may reduce the risk of esophageal stricture development. [3][4][5][6][7][8] Conversely, in the present case, severe esophageal injury progressed to an esophageal stricture. Despite severe mucosal injury to the entire esophagus, treatment was delayed by 1 week.…”

“…inhibitors, with additional empirical antibiotics in some cases. [3][4][5][6][7][8] The three cases involving the esophagus 3,5,8 did not progress to esophageal strictures. Therefore, partially dissolved powder, ingestion of large volumes of water afterward, or early treatment may reduce the risk of esophageal stricture development.…”

“…2 However, when picosulfate is dissolved in water, it induces an exothermic reaction that can cause chemical burning in the gastrointestinal tract mucosa. [3][4][5][6][7][8] To prevent Picolight-associated tissue injury, dissolution of this powder in more than 200 mL of water is strongly recommended. 2 On the other hand, dissolving it in a low volume of water results in a more acidic liquid, which can lead to corrosive esophageal injury.…”

“…Six cases of corrosive injuries in the oropharynx, 6 esophagus, 3,5,8 or stomach [3][4][5]7 caused by partially dissolved or undissolved picosulfate powder have been reported ( Table 1). The most common symptoms were burning sensations or pain in the throat, epigastrium, or chest, with hematemesis 5,8 or hoarseness 6 also occurring in some cases.…”