Standard bowel cleansing is highly ineffective in cirrhotic patients undergoing screening colonoscopy

Salso, A.; Leonardis, Francesco De; Lionetti, Raffaella; Lenci, Ilaria; Angélico, M.; Telese, Andrea; Baiocchi, Leonardo

doi:10.1016/j.dld.2015.02.013

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…Cirrhosis has been reported as a predictor of inadequate bowel preparation in previous studies 11,14 . Thus, standard bowel preparation was shown to be ineffective in cirrhotic patients 15 . Regarding this finding, several factors, including autonomic dysfunction, small bowel bacterial overgrowth, are suggested as causes which result in impaired intestinal motility 16,17 .…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for inadequate bowel preparation using low-volume polyethylene glycol (PEG) plus ascorbic acid for an outpatient colonoscopy

Shin

Kim

et al. 2019

Sci Rep

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Low-volume polyethylene glycol (PEG) plus ascorbic acid solutions are widely used for bowel cleansing before colonoscopy. This study aimed to investigate the pre-endoscopic predictive factors for inadequate preparation in subjects receiving low-volume PEG plus ascorbic acid. A prospective study was performed at Gangnam Severance Hospital, Korea, from June 2016 to December 2016. All participants received low-volume PEG plus ascorbic acid solutions for outpatient colonoscopy. The split-dose bowel preparation was administered in subject with morning colonoscopy while same day bowel preparation was used for afternoon colonoscopy. 715 patients were enrolled (mean age 56.1 years, 54.4% male), of which 138 (19.3%) had an inadequate bowel preparation. In multivariable analysis, cirrhosis (OR 4.943, 95% CI 1.191–20.515), low (less than 70%) compliance for three-day low-residual diet (OR 2.165, 95% CI 1.333–3.515), brown liquid rectal effluent (compared with clear or semi-clear effluent) (OR 7.604, 95% CI, 1.760–32.857), and longer time interval (≥2 hours) between last defecation and colonoscopic examination (OR 1.841, 95% CI, 1.190–2.849) were found as an independent predictors for inadequate preparation. These predictive factors may be useful in guiding additional intervention to improve quality of bowel preparation.

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Section: Discussionmentioning

confidence: 99%

Predictive factors for inadequate bowel preparation using low-volume polyethylene glycol (PEG) plus ascorbic acid for an outpatient colonoscopy

Shin

Kim

et al. 2019

Sci Rep

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“…The rate of failure to complete the bowel preparation and the incidence of side effects were comparable in 53 cirrhotics compared to 52 healthy subjects undergoing screening colonoscopy, according to an Italian 2015 study by Salso et al [ 113 ]. Despite this, nearly half of the cirrhotics (49% vs 5% control; P < 0.001) had poor bowel cleansing.…”

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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“…For example, a smaller study by Salso et al of 53 cirrhotics and 52 non-cirrhotics demonstrated that a significant portion of cirrhotic patients had suboptimal bowel preparation and a lower adenoma detection as compared to non-cirrhotics (though not statistically significant). 8 However, that study did not examine the concomitant use of medications like narcotics and betaadrenergic blockers which are known to affect gastrointestinal motility. In our study, we also observed worse bowel preparations in cirrhotic patients despite many of these patients concomitantly taking medications such as lactulose and beta-adrenergic blockers, which have been shown to decrease intestinal transit time, as well as rifaximin, which is used in treatment of SIBO.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, small studies have identified liver cirrhosis as an independent predictor of ineffective bowel cleansing. [8][9][10] This finding is suspected to result from impaired intestinal motility in cirrhotic patients, related to autonomic dysfunction, metabolic derangements, and/or small intestinal bacterial overgrowth. [11][12][13] It remains uncertain whether the extent of suboptimal bowel preparation at colonoscopy in cirrhotics is also present in patients with chronic liver disease without cirrhosis.…”

mentioning

confidence: 99%

Cirrhotic Patients Have Worse Bowel Preparation at Screening Colonoscopy than Chronic Liver Disease Patients without Cirrhosis

Anam

Karia

Jesudian

et al. 2016

Journal of Clinical and Experimental Hepatology

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Standard bowel cleansing is highly ineffective in cirrhotic patients undergoing screening colonoscopy

Cited by 8 publications

References 19 publications

Predictive factors for inadequate bowel preparation using low-volume polyethylene glycol (PEG) plus ascorbic acid for an outpatient colonoscopy

Predictive factors for inadequate bowel preparation using low-volume polyethylene glycol (PEG) plus ascorbic acid for an outpatient colonoscopy

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

Cirrhotic Patients Have Worse Bowel Preparation at Screening Colonoscopy than Chronic Liver Disease Patients without Cirrhosis

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