Bowel preparation before colonoscopy – is there an optimal preparation?

Czech version

Authors: Kmochová K.; Zavoral M.; Suchánek Š.
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN – VFN Praha
Published in: Gastroent Hepatol 2019; 73(5): 392-397
Category: Gastrointestinal Oncology: Review Article
doi: https://doi.org/10.14735/amgh2019392

Overview

Quality of bowel cleansing is essential for quality colonoscopy. The European Society of Gastrointestinal Endoscopy recommends that adequate bowel preparation should be reached in at least 90% of colonoscopies. Non-adequate bowel preparation occurs in 25% of colonoscopies, and it can cause periprocedural complications or reduce the detection of colorectal neoplasia. A very important consideration in the bowel preparation process is the patient’s education and motivation, and adherence to a low-fibre or a fluid diet on the day before colonoscopy. Compliance with the split-dose regime significantly improves the quality of bowel preparation and detection of colorectal neoplasia. The time between finishing the second half of the bowel preparation and colonoscopy should be no longer than 3–5 hours. The non-split regime can be used as an alternative regime for afternoon colonoscopy (same-day preparation). The quality of bowel cleansing should be evaluated in every colonoscopic report. For screening colonoscopy in the Czech Republic, it is obligatory to evaluate the quality of bowel preparation according to the Boston Bowel Preparation Scale. The most often used laxatives in CR are polyethylenglycol (4 l) and low volume solutions, such as oral sulphate solution, polyethylenglycol (2 l) and ascorbic acid, and sodium picosulfate and magnesium citric acid. According to previous studies, low volume solutions are as equally effective as polyethylenglycol (4 l). Prokinetics or enemas do not increase the quality of bowel cleansing and therefore their use is not recommended for bowel preparation. Addition of simeticon to a laxative can improve the quality of cleansing and also the detection of colorectal neoplasia.

Keywords:

colonoscopy – bowel preparation – quality of bowel preparation – quality of colonoscopy – detection of colorectal neoplasia

Sources

1. Hassan C, East J, Radealli F et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51 (8): 775–794. doi: 10.1055/a-0959-0505.

2. Falt P, Urban P, Vítek P et al. Koloskopie. Praha: Grada Publishing 2015: 51–60.

3. Froehlich F, Wietlisbach V, Gonvers JJ et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005; 61 (3): 378–384. doi: 10.1016/s0016-5107 (04) 02 776-2.

4. Hassan C, Fuccio L, Bruno M et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol 2012; 10 (5): 501–506. doi: 10.1016/j.cgh.2011.12.037.

5. Guo X, Yang Z, Zhao L et al. Enhanced instructions improve the quality of bowel preparation for colonoscopy: meta-analysis of randomized controlled trials. Gastrointest Endosc 2017; 85 (1): 90–97. doi: 10.1016/j.gie.2016.05.012.

6. Butt J, Bunn C, Paul E et al. The White Diet is preferred, better tolerated, and non-inferior to a clear-fluid diet for bowel preparation: a randomized controlled trial. J Gastroenterol Hepatol 2016; 31 (2): 355–363. doi: 10.1111/jgh.13078.

7. Banerjee R, Chaudhari H, Shah N et al. Addition of Lubiprostone to polyethylene glycol (PEG) enhances the quality & efficacy of colonoscopy preparation: a randomized, double-blind, placebo controlled trial. BMC Gastroenterology 2016; 16 (1): 133. doi: 10.1186/s12876-016-0542-0.

8. Kim HJ, Kim TO, Shin BC et al. Efficacy of prokinetics with a split-dose of polyethylene glycol in bowel preparation for morning colonoscopy: a randomized controlled trial. Digestion 2012; 86 (3): 194–200. doi: 10.1159/000339780.

9. Lever EL, Walter MH, Condon SC et al. Addition of enemas to oral lavage preparation for colonoscopy is not necessary. Gastrointest Endosc 1992; 38 (3): 369–372. doi: 10.1016/s0016-5107 (92) 70435-0.

10. Pan P, Zhao SB, Li BH et al. Effect of supplemental simethicone for bowel preparation on adenoma detection during colonoscopy: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2019; 34 (2): 314–320. doi: 10.1111/jgh.14401.

11. Beilenhoff U, Biering H, Blum R et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – Update 2018. Endoscopy 2018; 50 (12): 1205–1234. doi: 10.1055/a-0759-1629.

12. Martel M, Barkun AN, Menard C et al. Split-dose preparations are superior to day-before bowel cleansing regimens: a meta-analysis. Gastroenterology 2015; 149 (1): 79–88. doi: 10.1053/j.gastro.2015.04.004.

13. Radaelli F, Paggi S, Hassan C et al. Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an organised screening programme. Gut 2017; 66 (2): 270–277. doi: 10.1136/gutjnl-2015-310685.

14. Pohl J, Halphen M, Kloess HR et al. Impact of the quality of bowel cleansing on the efficacy of colonic cancer screening: a prospective, randomized, blinded study. PLoS One 2015; 10 (5): e0126067. doi: 10.1371/journal.pone.0126067.

15. Seo EH, Kim TO, Park MJ et al. Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study. Gastrointest Endosc 2012; 75 (3): 583–590. doi: 10.1016/j.gie.2011.09.029.

16. Eun CS, Han DS, Hyun YS et al. The timing of bowel preparation is more important than the timing of colonoscopy in determining the quality of bowel cleansing. Dig Dis Sci 2011; 56 (2); 539–544. doi: 10.1007/s10620-010-1457-1.

17. Shaukat A, Malhotra A, Greer N et al. Systematic review: outcomes by duration of NPO status prior to colonoscopy. Gastroenterol Res Pract 2017. 3914942. doi: 10.1155/2017/3914942.

18. Cheng YL, Huang KW, Liao WC et al. Same-day versus split-dose bowel preparation before colonoscopy: a meta-analysis. J Clin Gastroenterol 2018; 52 (5): 392–400. doi: 10.1097/MCG.0000000000000860.

19. Avalos DJ, Castro FJ, Zuckerman MJ et al. Bowel preparations administered the morning of colonoscopy provide similar efficacy to a split dose regimen: a meta analysis. J Clin Gastroenterol 2018; 52 (10): 859–868. doi: 10.1097/MCG.0000000000000866.

20. SÚKL. Fortrans – souhrn údajů o přípravku. [online]. Dostupné z: www.sukl.cz/modules/medication/detail.php?kod=0058827.

21. Rex DK, Di Palma JA, Rodriguez R et al. A randomized clinical study comparing reduced-volume oral sulfate solution with standard 4-liter sulfate-free electrolyte lavage solution as preparation for colonoscopy. Gastrointest Endosc 2010; 72 (2): 328–336. doi: 10.1016/j.gie.2010.03.1054.

22. Xie Q, Chen L, Zhao F et al. A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoscopy. PLoS One 2014; 9 (6): e99092. doi: 10.1371/journal.pone.0099092.

23. Jin Z, Lu Y, Zhou Y et al. Systematic review and meta-analysis: sodium picosulfate/magnesium citrate vs. polyethylene glycol for colonoscopy preparation. Eur J Clin Pharmacol 2016; 72 (5): 523–532. doi: 10.1007/s00228-016-2013-5.

24. SÚKL. Eziclen – souhrn údajů o přípravku. [online]. Dostupné z: www.sukl.cz/modules/medication/detail.php?kod=0183550.

25. Kmochová K, Grega T, Vojtěchová G et al. Porovnání roztoku sulfátových solí a polyetylenglykoluv efektivitě střevní přípravy před koloskopií – randomizovaná, zaslepená studie. Gastroent Hepatol 2018; 72 (5): 397–400. doi: 10.14735/amgh2018397.

26. Lee HH, Lim CH, Kim JS et al. Comparison between an oral sulfate solution and a 2 l of polyethylene glycol + ascorbic acid as a split dose bowel preparation for colonoscopy. J Clin Gastroenterol 2018. In press. doi: 10.1097/MCG.0000000000001137.

27. Rex DK, DiPalma JA, McGowan J et al. A comparison of oral sulfate solution with sodium picosulfate: magnesium citrate in split doses as bowel preparation for colonoscopy. Gastrointest Endosc 2014; 80 (6): 1113–1123. doi: 10.1016/j.gie.2014.05.329.

28. SÚKL. Moviprep – souhrn údajů o přípravku. [online]. Dostupné z: www.sukl.cz/modules/medication/detail.php?kod=0170244.

29. Moon CM, Park DI, Choe YG et al. Randomized trial of 2-L polyethylene glycol + ascorbic acid versus 4-L polyethylene glycol as bowel cleansing for colonoscopy in an optimal setting. J Gastroenterol Hepatol 2014; 29 (6): 1223–1228. doi: 10.1111/jgh.12521.

30. SÚKL. Picoprep – souhrn údajů o přípravku. [online]. Dostupné z: www.sukl.cz/modules/medication/detail.php?kod=0191323.

31. Mathus-Vliegen EMH, van der Vliet K, Wignand-van der Storm IJ et al. Split-dose bowel cleansing with picosulphate is safe and better tolerated than 2- l polyethylene glycol solution. Eur J Gastroenterol Hepatol 2018; 30 (7): 709–717. doi: 10.1097/MEG.0000000000001 120.

32. Lim YJ, Hong SJ. What is the best strategy for successful bowel preparation under special conditions? World J Gastroenterol 2014; 20 (11): 2741–2745. doi: 10.3748/wjg.v20.i11.2741.

33. Lawrance IC, Willert RP, Murray K. Bowel cleansing for colonoscopy: prospective randomized assessment of efficacy and of induced mucosal abnormality with three preparation agents. Endoscopy 2011; 43 (5): 412–418. doi: 10.1055/s-0030-1256193.

34. Kwak MS, Cha JM, Yang HJ et al. Safety and efficacy of low-volume preparation in the elderly: oral sulfate solution on the day before and split-dose regimens (SEE SAFE) study. Gut Liver 2019; 13 (2): 176–182. doi: 10.5009/gnl1 8214.

35. Jung YS, Lee CK, Eun CS et al. Low-volume polyethylene glycol with ascorbic acid for colonoscopy preparation in elderly patients: a randomized multicenter study. Digestion 2016; 94 (2): 82–91. doi: 10.1159/000448887.

36. Lee JM, Keum B, Yoo IK et al. Polyethylene glycol plus ascorbic acid for bowel preparation in chronic kidney disease. Medicine (Baltimore) 2016; 95 (36): e4755. doi: 10.1097/MD.0000000000004755.

37. Gkolfakis P, Tziatzios G, Papanikolaou IS et al. Strategies to improve hospitalized patients’ quality of bowel preparation for colonoscopy: a systematic review and meta-analysis. Gastroenterol Res Pract 2019. 5147208. doi: 10.1155/2019/5147208.

38. Sohn N, Weinstein MA. Management of the poorly prepared colonoscopy patient: colonoscopic colon enemas as a preparation for colonoscopy. Dis Colon Rectum 2008; 51 (4): 462–466. doi: 10.1007/s10350-007-9127-x.

39. Horiuchi A, Nakayama Y, Kajiyama M et al. Colonoscopic enema as rescue for inadequate bowel preparation before colonoscopy: a prospective, observational study. Colorectal Dis 2012; 14 (10): 735–739. doi: 10.1111/j.1463-1318.2012.03107.x.

40. Calderwood AH, Schroy PC 3rd, Leiberman DA et al. Boston bowel preparation scores provide a standardized definition of adequate for describing bowel cleanliness. Gastrointest Endosc 2014; 80 (2): 269–276. doi: 10.1016/j.gie.2014.01.031.

41. Harrison NM, Hjelkrem MC. Bowel cleansing before colonoscopy: balancing efficacy, safety, cost and patient tolerance. World J Gastrointest Endosc 2016; 8 (1): 4–12. doi: 10.4253/wjge.v8.i1.4.