Can a bowel preparation exacerbate heart failure?

Parikh, Kalindi; Weitz, Howard H.

doi:10.3949/ccjm.77a.10025

Cited by 14 publications

(8 citation statements)

References 19 publications

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“…However, many studies have demonstrated poor compliance because of the large volumes of these solutions [18]. The full-dose PEG regimen has been associated with complications such as Mallory-Weiss tears due to the vomiting [19], and a large amount of PEG expands plasma volume by 6-17%, which may exacerbate heart failure in some patients [20].…”

Section: Discussionmentioning

confidence: 99%

A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy

Yoo¹,

Lee²,

Chun

et al. 2015

Digestive and Liver Disease

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Section: Discussionmentioning

confidence: 99%

A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy

Yoo¹,

Lee²,

Chun

et al. 2015

Digestive and Liver Disease

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“…Also, coronary heart disease has been identified as a risk factor for severe desaturation and relevant electrocardiographic changes during endoscopic sedation[ 130 ]. Furthermore, several studies have found that these solutions may be harmful to patients with heart disease due to the potential increase in plasma volume and their effects on electrolyte disturbances[ 131 ].…”

Section: Specific Clinical Settingsmentioning

confidence: 99%

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

Shahini¹,

Sinagra²,

Vitello³

et al. 2023

World J Gastroenterol

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Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.

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“…However, some recent case reports have raised safety concerns related to the occurrence of cardiac events after the use of PEG-based bowel preparations. A few case reports involving patients who experienced heart failure exacerbation after using PEG-based bowel preparations for colonoscopy have been published [ 4 , 5 , 6 ]. Furthermore, another case report has suggested the possible association of PEG use with the risk of cardiac arrhythmia [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, these bowel preparation agents can cause adverse events, including electrolyte imbalances and acute renal failure [ 2 , 3 ]. Case reports of rare adverse cardiac events, such as heart failure exacerbation related to bowel preparation, have been published [ 4 , 5 , 6 ]. Recently, one case report suggested the possible association of purgative use and the development of atrial fibrillation (AF) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Bowel Preparation and Subsequent Colonoscopy Is Associated with the Risk of Atrial Fibrillation: A Population-Based Case-Crossover Study

Jung

Jee

et al. 2022

JPM

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This study aimed to clarify the association of the risk of atrial fibrillation (AF) with bowel preparation and subsequent colonoscopy through population-based case-crossover analysis. Patients who developed new-onset AF after undergoing colonoscopy following bowel preparation were included. For each patient, one hazard period and four control periods were matched at specified time windows. Among 189,613 patients with AF, 84 patients (mean age: 72.4 years) finally met the inclusion criteria. Most patients used polyethylene glycol (PEG)-based solutions (2 L PEG + ascorbic acid (n = 56), 4 L PEG (n = 21)) as purgatives and had hypertension (n = 75). A significant association of bowel preparation and colonoscopy with AF occurrence was found in all time windows. The proportion of patients with bowel preparation and colonoscopy was higher during the hazard period than during the control periods. In the 1-, 2-, 4-, 8-, and 12-week time windows, the proportions were 11.9% vs. 4.2%, 13.1% vs. 4.8%, 16.7% vs. 6.3%, 28.6% vs. 11.9%, and 29.8% vs. 14.0%, and the odd ratios (ORs) were 3.11, 3.01, 3.00, 2.96, and 2.61, respectively. Bowel preparation and undergoing colonoscopy was associated with the risk of AF and this examination need to be performed with caution especially in elderly patients with hypertension.

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Can a bowel preparation exacerbate heart failure?

Cited by 14 publications

References 19 publications

A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy

A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

Bowel Preparation and Subsequent Colonoscopy Is Associated with the Risk of Atrial Fibrillation: A Population-Based Case-Crossover Study

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