Review

Authors: David Kastenberg, Gerald Bertiger, Stuart Brogadir...

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred to in the literature, these differ greatly in grading methodology and categorization criteria. Published reliability and validity data are available for five bowel preparation quality assessment scales, which vary in several key attributes. However, clinicians and researchers continue to use a variety of bowel preparation quality measures, including nonvalidated scales, leading to potential confusion and difficulty when comparing quality results among clinicians and across clinical trials. Optimal clinical criteria for bowel preparation quality remain controversial. The use of validated bowel preparation quality scales with stringent but simple scoring criteria would help clarify clinical trial data as well as the performance of colonoscopy in clinical practice related to quality measurements.

Topics: Cathartics; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; False Negative Reactions; Humans; Practice Guidelines as Topic; Quality Assurance, Health Care

PubMed: 30018478
DOI: 10.3748/wjg.v24.i26.2833

Review

Authors: Endrit Shahini, Emanuele Sinagra, Alessandro Vitello...

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.

Topics: Humans; Aged; Cathartics; Colonoscopy; Polyethylene Glycols; Colon; Ascorbic Acid

PubMed: 37077514
DOI: 10.3748/wjg.v29.i11.1685

Authors: Edwin J Lai, Audrey H Calderwood, Gheorghe Doros...

BACKGROUND

Few bowel-preparation rating scales have been validated. Most scales were intended for comparing oral purgatives and fail to account for washing and/or suctioning by the endoscopist. This limits their utility in studies of colonoscopy outcomes, such as polyp-detection rates.

OBJECTIVE

To develop a valid and reliable scale for use in colonoscopy outcomes research.

SETTING

Academic medical center.

METHODS

We developed the Boston bowel preparation scale (BBPS), a 10-point scale that assesses bowel preparation after all cleansing maneuvers are completed by the endoscopist. We assessed interobserver and intraobserver reliability by using video footage of colonoscopies viewed on 2 separate occasions by 22 clinicians. We then applied the BBPS prospectively during screening colonoscopies and compared BBPS scores with clinically meaningful outcomes, including polyp-detection rates and procedure times.

RESULTS

The intraclass correlation coefficient (a measure of interobserver reliability) for BBPS scores was 0.74. The weighted kappa (a measure of intraobserver reliability) for scores was 0.77 (95% CI, 0.66-0.87). During 633 screening colonoscopies, the mean (SD) BBPS score was 6.0 +/- 1.6. Higher BBPS scores (> or =5 vs <5) were associated with a higher polyp-detection rate (40% vs 24%, P < .02). BBPS scores were inversely correlated with colonoscope insertion (r = -0.16, P < .003) and withdrawal (r = -0.23, P < .001) times.

LIMITATIONS

Single-center study.

CONCLUSIONS

The BBPS is a valid and reliable measure of bowel preparation. It may be well suited to colonoscopy outcomes research because it reflects the colon's cleanliness during the inspection phase of the procedure.

Topics: Cathartics; Colonoscopy; Humans; Observer Variation; Preoperative Care; Prospective Studies; Reproducibility of Results

PubMed: 19136102
DOI: 10.1016/j.gie.2008.05.057

Review

Authors: Glen S Markowitz, Mark A Perazella

Acute phosphate nephropathy (APhN) is a clinical pathological entity characterized by acute and subsequent chronic renal failure following exposure to oral sodium phosphate (OSP) bowel purgatives. Renal biopsy findings include acute and chronic tubular injury with prominent tubular and interstitial calcium phosphate deposits. Risk factors for APhN include older age, female gender, hypertension, chronic kidney disease (CKD), and treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. The pathomechanism of APhN involves hypovolemia-induced avid proximal salt and water reabsorption, delivery of a large phosphate load to the distal nephron, and precipitation of calcium phosphate in the distal tubule and collecting duct. To date, 37 cases of biopsy-proven APhN have been reported, and epidemiologic studies have produced inconsistent results regarding the incidence of acute kidney injury (AKI) following the use of OSP purgatives. OSP solution was withdrawn from the market in December of 2008, but OSP tablets, offered by prescription only, remain available. Prevention of APhN is best achieved by avoiding OSP in high-risk patients, aggressive hydration before, during, and after OSP administration, minimizing the dose of OSP, and maintaining a minimum of a 12 h interval between OSP administrations.

Topics: Acute Disease; Acute Kidney Injury; Administration, Oral; Biopsy; Calcium Phosphates; Cathartics; Cohort Studies; Female; Humans; Incidence; Kidney Failure, Chronic; Middle Aged; Phosphates; Risk Factors

PubMed: 19675530
DOI: 10.1038/ki.2009.308

Review

Authors: Atif Zaman

Irritable bowel syndrome (IBS) is one of the most common diagnoses made in the primary care setting and is responsible for up to 40% of referrals to gastroenterologists. Approximately 70% of persons who meet the diagnostic criteria for IBS do not seek health care, and the remaining account for 12% of visits to primary care providers. IBS is a functional bowel disordered comprising abdominal pain associated with defecation or a change in bowel habit with features of disordered defecation and distension in the absence of any demonstrable abnormality. The diagnosis is based on clinical findings and the exclusion of other disorders. New pharmaceutical agents are available to treat the underlying disorder; however, the treatment of IBS still involves a comprehensive, multicomponent approach that includes medical management of dominant symptoms, dietary modifications, and, possibly, psychotherapy.

Topics: Antidepressive Agents; Antidiarrheals; Cathartics; Cholinergic Antagonists; Colonic Diseases, Functional; Humans; Parasympatholytics; Patient Care Team

PubMed: 12739324
DOI: 10.1016/s1098-3597(02)90003-7

Review

Authors: Jae Seung Soh, Kyung-Jo Kim

Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol (PEG) solution is the most frequently used preparation for bowel cleansing, patients are often unwilling to take PEG solution due to its large volume, poor palatability, and high incidence of adverse events, such as abdominal bloating and nausea. Other purgatives include osmotic agents (e.g., sodium phosphate, magnesium citrate, and sodium sulfate), stimulant agents (e.g., senna, bisacodyl, and sodium picosulfate), and prokinetic agents (e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients' adherence. Some such solutions have been found in several published studies to not be inferior to PEG alone in terms of bowel cleansing quality. Although combination methods showed similar efficacy and safety, the value of these studies is limited by shortcomings in study design. New effective and well-tolerated combination preparations are required, in addition to rigorous new validated studies.

Topics: Administration, Oral; Cathartics; Colonoscopy; Defecation; Drug Therapy, Combination; Gastrointestinal Motility; Humans; Medication Adherence; Polyethylene Glycols; Therapeutic Irrigation; Treatment Outcome

PubMed: 26973388
DOI: 10.3748/wjg.v22.i10.2915

Randomized Controlled Trial

Efficacy of Polyethylene Glycol Electrolyte Powder Combined With Linaclotide for Colon Cleansing in Patients With Chronic Constipation Undergoing Colonoscopy: A Multicenter, Single-Blinded, Randomized Controlled Trial.

Authors: Lianli Wang, Yue Zhang, Jingyao Li...

INTRODUCTION

Constipation is an independent risk factor for poor bowel preparation. This study aimed to evaluate the bowel cleansing efficacy and safety of polyethylene glycol (PEG) combined with linaclotide (lin) for colonoscopy in patients with chronic constipation (CC).

METHODS

This single-blinded, randomized, controlled, and multicenter study was conducted from July 2021 to December 2022 at 7 hospitals. Patients with CC who underwent colonoscopies were enrolled and randomly assigned to 4 groups with split-PEG regimens: 4L-PEG group, 4L-PEG+1d-Lin group, 3L-PEG+1d-Lin group, and 3L-PEG+3d-Lin group. The primary outcome was rates of adequate bowel preparation, defined as a total BBPS score ≥6 and a score ≥2 for each segment. Secondary outcomes were adverse effects, sleep quality, willingness to repeat the colonoscopy, adenoma detection rate, and polyp detection rate.

RESULTS

Five hundred two patients were enrolled. The rates of adequate bowel preparation (80.0% vs 60.3%, P < 0.001; 84.4% vs 60.3%, P < 0.001) and the total Boston Bowel Preparation Scale (BBPS) scores (6.90 ± 1.28 vs 6.00 ± 1.61, P < 0.001; 7.03 ± 1.24 vs 6.00 ± 1.61, P < 0.01) in the 4L-PEG+1d-Lin group and the 3L-PEG+3d-Lin group were superior to that in the 4L-PEG group. Compared with the 4L-PEG group, the 4L-PEG+1d-Lin group (66.7% vs 81.7%, P = 0.008) and the 3L-PEG+3d-Lin group (75.0% vs 81.7%, P = 0.224) had a lower percentage of mild adverse events. No statistically significant difference in willingness to repeat the colonoscopy, sleep quality, polyp detection rate, or adenoma detection rate was observed among groups.

DISCUSSION

PEG combined with linaclotide might be an effective method for bowel preparation before colonoscopy in patients with CC.

Topics: Humans; Colonoscopy; Polyethylene Glycols; Male; Female; Constipation; Middle Aged; Single-Blind Method; Cathartics; Chronic Disease; Aged; Adult; Peptides; Powders; Treatment Outcome; Electrolytes

PubMed: 38713137
DOI: 10.14309/ctg.0000000000000708

Randomized Controlled Trial

Authors: Kristina Žukauskaitė, Angela Horvath, Žilvinas Gricius...

BACKGROUND

Postoperative complications after colorectal cancer surgery have been linked to the gut microbiome. However, the impact of mechanical bowel preparation using oral preparation agents or rectal enema on postoperative infections remains poorly understood. This study aimed to compare the impact of oral preparation and rectal enema on the gut microbiome and postoperative complications.

METHODS

This open-label pilot RCT was conducted at the National Cancer Institute, Vilnius, Lithuania. Patients with left-side colorectal cancer scheduled for elective resection with primary anastomosis were randomized 1 : 1 to preoperative mechanical bowel preparation with either oral preparation or rectal enema. Stool samples were collected before surgery, and on postoperative day 6 and 30 for 16S rRNA gene sequencing analysis. The primary outcome was difference in β-diversity between groups on postoperative day 6.

RESULTS

Forty participants were randomized to oral preparation (20) or rectal enema (20). The two groups had similar changes in microbiome composition, and there was no difference in β-diversity on postoperative day 6. Postoperative infections occurred in 12 patients (32%), without differences between the study groups. Patients with infections had an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.

CONCLUSION

Mechanical bowel preparation with oral preparation or rectal enema resulted in similar dysbiosis. Patients who experienced postoperative infections exhibited distinct gut microbiome compositions on postoperative day 6, characterized by an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.

REGISTRATION NUMBER

NCT04013841 (http://www.clinicaltrials.gov).

Topics: Humans; Gastrointestinal Microbiome; Male; Female; Colorectal Neoplasms; Aged; Middle Aged; Enema; Cathartics; Preoperative Care; Pilot Projects; Postoperative Complications

PubMed: 39222391
DOI: 10.1093/bjs/znae213

Review

Authors: Masateru Ono

Resin glycosides are well known as purgative ingredients, which are characteristic of certain crude drugs such as Mexican Scammony Radix, Orizabae Tuber, and Jalapae Tuber, all of which originate from Convolvulaceae plants. Depending on their solubility in ether, these are roughly classified into two groups-jalapin (soluble) and convolvulin (insoluble). Almost all jalapins hitherto isolated and characterized had common intramolecular macrocyclic ester structures. These are composed of 1 mol of oligoglycoside of hydroxyl fatty acid (glycosidic acid) partially acylated by some organic acids at the sugar moiety, some examples of which are ester-type dimers. On the other hand, convolvulin is regarded as an oligomer of a variety of acylated glycosidic acids. This review describes the isolation and structural elucidation of resin glycosides from some Convolvulaceae plants, including Ipomoea operculata, Pharbitis nil, Quamoclit pennata, Calystegia soldanella, and I. muricata.

Topics: Cathartics; Convolvulaceae; Glycosides; Humans; Molecular Structure; Plant Extracts; Plant Roots; Plant Tubers; Resins, Plant; Seeds

PubMed: 28748432
DOI: 10.1007/s11418-017-1114-5

Authors: Gregory P Rubin

Topics: Biofeedback, Psychology; Cathartics; Child; Cisapride; Constipation; Humans; Lactulose

PubMed: 12643364
DOI: No ID Found