The timing of bowel preparation before colonoscopy determines the quality of cleansing, and is a significant factor contributing to the detection of flat lesions: A randomized study

Parra‐Blanco, Adolfo; Nicolás–Pérez, David; Gimeno–García, Antonio Z.; Grosso, Begoña; Jiménez, Alejandro; Ortega, Joaquı́n M.; Quintero, Enrique

doi:10.3748/wjg.v12.i38.6161

Cited by 228 publications

(152 citation statements)

References 24 publications

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“…It should be noted that PEG-EA subjects were permitted a more liberal diet, including a regular breakfast and a light lunch, before bowel cleansing in contrast to sulfate subjects who were restricted to clear liquids aft er a light breakfast. Th e infl uence of these dietary diff erences on bowel preparation quality is unknown.Th e fi ndings of Di Palma et al confi rm the results of previously published studies (3,9,10) showing that a split-dosing strategy, in which a proportion of the bowel preparation is taken on the morning of the examination, results in superior bowel cleansing compared with a regimen that provides the entire bowel preparation the day before the examination. Splitdosing should now be a practice standard for pre-colonoscopic…”

supporting

confidence: 59%

“…Th e importance of bowel preparation before colonoscopy cannot be understated. Inadequate colon cleansing is associated with lower endoscopic yield for adenomas (1,2) , decreased fi nd rates for fl at lesions (3), and longer examinations (2) . Unfortunately, bowel preparation is oft en inadequate to permit complete examination of the colon (1) , necessitating shorter screening and surveillance intervals.…”

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confidence: 99%

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Editorial: A Light Breakfast, a Jug of Salt Water and Bowel

Balaban¹

2009

Am J Gastroenterol

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Successful colonoscopy is predicated on achieving adequate colon cleansing. An ideal bowel preparation would be low in volume, acceptable to patients, reliable in cleansing effi cacy, and safe. The study by Di Palma et al. in this issue shows that a novel, low-volume (960 ml) preparation of mixed sulfate salts can achieve excellent bowel cleansing with acceptable tolerability and minimal electrolyte shifts. A split-dosing strategy, with a proportion of the preparation administered on the day of colonoscopy, achieved a 97.2 % preparation success rate vs. 82.4 % using a regimen provided entirely the day before colonoscopy. These results were comparable with control groups using a commercially available polyethylene glycol solution. Endoscopists and patients alike should be encouraged by the trend toward lower-dose bowel cleansing regimens that achieve equivalent effi cacy compared with large-volume preparations. Am J Gastroenterol 2009; 104:2285-2287 doi: 10.1038/ajg.2009 It could be argued that there is no medication more commonly prescribed by a busy endoscopist than a bowel preparation. Yet, the volume of scientifi c literature on the pharmacokinetics, efficacy, and side eff ects of bowel cleansing agents used for colonoscopy and other medical procedures is scant when compared with other agents used for digestive health. Th e importance of bowel preparation before colonoscopy cannot be understated. Inadequate colon cleansing is associated with lower endoscopic yield for adenomas (1,2) , decreased fi nd rates for fl at lesions (3), and longer examinations (2) . Unfortunately, bowel preparation is oft en inadequate to permit complete examination of the colon (1) , necessitating shorter screening and surveillance intervals. Perhaps most importantly, patients report that the bowel preparation is both the leading deterrent to undergoing screening colonoscopy (4) and the most diffi cult part of the examination (5) .In this issue of the American Journal of Gastroenterology , Di Palma et al . report the results of a randomized, multicenter, industry-sponsored, endoscopist-blinded trial of a novel oral sulfate solution for pre-colonoscopic bowel preparation (6) . Study subjects were randomized to one of two therapeutic dosing strategies: same-day (PM before examination) vs. split-dose (PM / AM) preparation. Case subjects used two 480-ml doses of a solution comprised of sodium, potassium, and magnesium sulfate salts. Controls used two 1-L doses of a commercially available polyethylene glycol solution with electrolytes and ascorbic acid (PEG-EA, MoviPrep, Salix Pharmaceuticals, Morrisville, NC). Th e primary endpoint was bowel preparation success defi ned as a score of " excellent " or " good " using a previously published scale (7,8) . Tolerability was assessed using a questionnaire administered on the date of the examination.Th e intention-to-treat analysis included 387 subjects randomized to the same-day dosing strategy (194 sulfate, and 364 subjects in the split-dose strategy (181 sulfate, 183 PEG-EA). Bowel preparati...

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supporting

confidence: 59%

mentioning

confidence: 99%

Editorial: A Light Breakfast, a Jug of Salt Water and Bowel

Balaban¹

2009

Am J Gastroenterol

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“…Despite more than 14 million colonoscopies being performed each year, the historic rates for adequate cleansing are unacceptably low and range from 70-82% (10)(11)(12)(13). Recent studies have shown that ingesting at least part of the purgative on the day of colonoscopy and coordinating the final dose of purgative with the start time of colonoscopy is more likely to result in adequate colon cleansing (2)(3)(4)(5). Generally, this is accomplished by splitting the purgative between the evening prior and the morning of colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Both groups of patients in the study presented herein were asked to complete the second dose of PEG-ELS 4 hours before their scheduled procedure time. Aspiration, though rare, is serious and has not been reported in several studies that have specifically evaluated PEG-ELS dosing on the day of colonoscopy (2)(3)(4)(5)8). Large published series of patients receiving propofol-based anesthesia for endoscopy have found aspiration to be a rare event.…”

Section: Discussionmentioning

confidence: 99%

“…Day-of-colon dosing can be achieved through two strategies -split (PM/AM) dosing where part of the purgative is administered the night prior to colonoscopy and the remainder within ~6 hours of the procedure, and morning-only (AM-only) dosing where the entire prep is taken on the day of colonoscopy (2)(3)(4)(5). By linking the final dose of purgative to the timing of colonoscopy, a greater chance of adequate cleansing is assured regardless of the time of colonoscopy.…”

Section: Introductionmentioning

confidence: 99%

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