Clinical trial: the efficacy and safety of routine bowel cleansing agents for elective colonoscopy in persons with spinal cord injury – a randomized prospective single‐blind study

Ancha, Hanumantha R.; Spungen, Ann M.; Bauman, William A.; Rosman, Alan S.; Shaw, Spencer; Hunt, Kristel; Post, James; Galea, Marinella; Korsten, Mark A.

doi:10.1111/j.1365-2036.2009.04147.x

Cited by 22 publications

(28 citation statements)

References 29 publications

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“…8,20 To our knowledge, there is no published regime that can be considered satisfactory, and the use of a hyperosmolar agent alone is inadequate. Acknowledging concerns of acute phosphate nephropathy following oral sodium phosphate, 8 we are trialling a new regime based on two days of sodium picosulfate+magnesium+citrate (Fresenius Kabi) and a phosphate enema the morning of the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…6 Detection of occult neoplastic disease is difficult due to higher rates of gastrointestinal complaints 6,7 and the high frequency of PR bleeding should exclude SCI patients from faecal occult blood testing. 3 Colonoscopy is challenging with difficulties in bowel preparation and low intubation rates despite multiday bowel preparation, 3,8,9 and studies assessing yield and safety of colonoscopy after SCI 3,8 have been limited by a small sample size or lack of a control group. We seek to highlight the difficulties with colonoscopy after SCI using a noninjured control group but to emphasise its importance by demonstrating the rates of benign and malignant diseases.…”

Section: Introductionmentioning

confidence: 99%

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Colonoscopy after spinal cord injury: a case–control study

2014

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Design: An age-and gender-matched case-control study. Objective: To compare colonoscopy after spinal cord injury (SCI) with the general population in terms of indications, bowel preparation, technical success and disease detection. Setting: Victoria, Australia. Methods: Consecutive SCI colonoscopies between January 1998 and February 2013 were compared with a randomly selected ageand gender-matched control group. Injury level, indication for procedure and demographics were collected. Outcome measures included quality of bowel preparation, completion rates, procedural duration and benign and malignant disease detection. Results: A total of 440 colonoscopies were assessed, comprising 148 SCI patients and 292 age-and gender-matched controls. Both the groups were of similar age (54.7 years vs 54.5 years, P = 0.906) and comprised predominantly males (87.1% vs 86.3%, P = 0.919). SCI colonoscopies were more often performed to investigate abnormalities (85.1% vs 58.2%, Po0.001) than for screening or surveillance (18.2% vs 40.8%, Po0.001). Unsatisfactory bowel preparation was recorded more often in the SCI group (36.0% vs 13.0%, Po0.001) and completion rates were lower (75.7% vs 93.1%, Po0.001). Overall disease detection was lower in the SCI group (45.3% vs 59.6%, Po0.006). The polyp detection rate was lower for SCI (11.4% vs 25.3%, P = 0.001). The rate of diagnosis of malignancy was equivalent (2.7% vs 3.0%, P = 0.904). Conclusion: SCI patients have the same risk of malignancy as the general population and are less likely to undergo screening colonoscopy. Colonoscopy is then limited by poor bowel preparation and lower completion rates with a subsequent lower polyp detection rate. INTRODUCTIONThere is both an increasing prevalence and increasing average age of SCI patients. 1 Despite improvements in acute mortality, there is still a decreased life expectancy now most frequently attributed to cancer. 2 Colorectal cancer (CRC) screening in this group has received little attention despite reports of an at least equivalent cancer risk 3-5 and presentation with more advanced disease. 6 Detection of occult neoplastic disease is difficult due to higher rates of gastrointestinal complaints 6,7 and the high frequency of PR bleeding should exclude SCI patients from faecal occult blood testing. 3 Colonoscopy is challenging with difficulties in bowel preparation and low intubation rates despite multiday bowel preparation, 3,8,9 and studies assessing yield and safety of colonoscopy after SCI 3,8 have been limited by a small sample size or lack of a control group. We seek to highlight the difficulties with colonoscopy after SCI using a noninjured control group but to emphasise its importance by demonstrating the rates of benign and malignant diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Colonoscopy after spinal cord injury: a case–control study

2014

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“…The bowel effluent that results from the bowel preparation process can complicate skin management and cause pressure ulcers, a common co-morbidity in this population. [7][8][9] Also, many persons with SCI&D have concomitant injury to their autonomic nervous system, which can have many adverse consequences.…”

Section: Introductionmentioning

confidence: 99%

Colonoscopy is high yield in spinal cord injury

Hayman

Guihan

Fisher

et al. 2013

The Journal of Spinal Cord Medicine

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Objectives/background: Colorectal cancer (CRC) can be prevented by routine colonoscopy. CRC screening in special populations, e.g. spinal cord injury and disorders, presents unique barriers and, potentially, a higher risk of complications. We were concerned about potentially higher risks of complications and sought to determine the safety of colonoscopy. Methods: Retrospective observational design using medical record review for 311 patients who underwent 368 colonoscopies from two large VA SCI centers from 1997-2008. Patient demographics and peri-procedural characteristics, including indication, bowel prep quality, and pathological findings are presented. Descriptive statistics are presented. Results: The population was predominantly male and Caucasian, and 199 (64%) had high-level injuries (T6 or above). Median age at colonoscopy was 61 years (interquartile range 53-69). Just <1/2 of the colonoscopies were diagnostic, usually for evidence of rectal bleeding. Although a majority of colonoscopies were reported as poorly prepped, the proportion that were adequately prepped increased over time (from 3.7 to 61.3%, P = <0.0001). Of the 146 polyps removed, 101 (69%) were adenomas or carcinomas. Ten subjects had 11 complications, none of which required surgical intervention. Conclusions: Although providing quality colonoscopic care in this population is labor intensive, the data suggests that it appears safe and therapeutically beneficial. The results indicate that the risk of screening is outweighed by the likelihood of finding polyps. Recognition of the benefit of colonoscopy in this population may have improved bowel prep and reporting over time. Spinal cord injury providers should continue to offer screening or diagnostic colonoscopy to their patients when indicated, while being aware of the special challenges that they face.

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“…Standard bowel cleansing preparations for screening colonoscopy used in the general population when applied to the SCI population have usually resulted in suboptimal bowel cleansing and unacceptable OSs. 10 In the current study, using an OS of ≤3 as the criterion for an acceptable bowel preparation, neither PIEE nor PEG produced an acceptable bowel preparation in subjects with SCI. Each bowel cleaning approach was not significantly different from the other, and neither one provided more than half of the subjects in either group with an acceptable OS prior to elective colonoscopy.…”

Section: Discussionmentioning

confidence: 52%

“…This supposition is supported by our prior work, in which the authors observed that ∼75% of individuals with SCI had suboptimal bowel preparation for elective colonoscopy when being electively screened for premalignant lesions. 10 Another report found that patients with SCI received fewer colonoscopies than that performed in the general population. 11 The unfavorable combination of a decreased rate of elective colonoscopic screening and generally poor quality of bowel preparations would be anticipated to heighten the rate of missed or delayed polyp detection, thus increasing the risk for the subsequent occurrence of CRC in individuals with SCI.…”

Section: Introductionmentioning

confidence: 99%

Comparison between pulsed irrigation enhanced evacuation and polyethylene glycol-electrolyte lavage solution for bowel preparation prior to elective colonoscopy in veterans with spinal cord injury

Lyons

Korsten²,

Spungen³

et al. 2014

The Journal of Spinal Cord Medicine

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Background: Poor preparation for elective colonoscopy is common in persons with spinal cord injury (SCI). This unsatisfactory outcome is likely due to long-standing difficulty with evacuation and decreased colonic motility. Our objective was to determine the most effective preparation for elective colonoscopy applying a novel and traditional approach to bowel cleansing. Methods: Twenty-four subjects with SCI were consented and scheduled to receive one of the two possible arms: pulsed irrigation enhanced evacuation (PIEE) or polyethylene glycol-electrolyte lavage solution (PEG; CoLyte ® ). The quality of the preparation was scored during the colonoscopy by applying the Ottawa scoring system. Results: Patients with SCI who received PIEE tended to have lower Ottawa scores and a higher percentage of acceptable preparations than did those who received PEG; however, the results were not statistically different. Conclusion: In this preliminary study in subjects with SCI, neither PIEE nor PEG produced acceptable bowel preparation for elective colonoscopy. Future studies should confirm our findings and consider studying alternative, more efficacious approaches to bowel cleansing prior to colonoscopic procedures in patients with SCI, which should provide better outcomes.Registration number for clinicaltrials.gov: NCT00745095.

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Clinical trial: the efficacy and safety of routine bowel cleansing agents for elective colonoscopy in persons with spinal cord injury – a randomized prospective single‐blind study

Abstract: SUMMARY BackgroundAs difficulty with evacuation is a common occurrence in individuals with spinal cord injury, preparation prior to colonoscopy may be suboptimal and, perhaps, more hazardous.

Cited by 22 publications

References 29 publications

Colonoscopy after spinal cord injury: a case–control study

Colonoscopy after spinal cord injury: a case–control study

Colonoscopy is high yield in spinal cord injury

Comparison between pulsed irrigation enhanced evacuation and polyethylene glycol-electrolyte lavage solution for bowel preparation prior to elective colonoscopy in veterans with spinal cord injury

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