A prospective, observational study of colonic mucosal abnormalities associated with orally administered sodium phosphate for colon cleansing before colonoscopy

Rejchrt, Stanislav; Bureš, Jan; Široký, Milan; Kopáčová, Marcela; Slezák, Luboš; Langr, F

doi:10.1016/s0016-5107(04)00158-0

Cited by 78 publications

(48 citation statements)

References 14 publications

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“…Currently, no uniform protocol is widely accepted and overnight fasting remains the standard preparation for SBCE. In a recently published prospective, multicenter randomized controlled study that included 291 patients, the authors concluded that a clear liquid diet and overnight fasting is sufficient to achieve an adequate level of cleanliness and is better the potential for misinterpretation of these lesions, some authors have contraindicated the use of NaP as a colonic cleansing preparation for patients with chronic diarrhea or in whom the diagnosis of inflammatory bowel disease is suspected [26][27][28] . Moreover, as the oral NaP preparation may induce changes in serum levels of potassium and sodium, it is usually not recommended for patients with chronic renal failure, ischemic heart disease or cirrhosis, who frequently undergo SBCE for investigation of iron deficiency anemia [25,29,30] .…”

Section: Discussionmentioning

confidence: 99%

Oral purgative and simethicone before small bowel capsule endoscopy

Rosa¹,

Barbosa²,

Magalhães³

et al. 2013

WJGE

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AIM:To evaluate small bowel cleansing quality, diagnostic yield and transit time, comparing three cleansing protocols prior to capsule endoscopy. METHODS:Sixty patients were prospectively enrolled and randomized to one of the following cleansing protocols: patients in Group A underwent a 24 h liquid diet and overnight fasting; patients in Group B followed protocol A and subsequently were administered 2 L of polyethylene glycol (PEG) the evening before the procedure; patients in Group C followed protocol B and were additionally administered 100 mg of simethicone 30 min prior to capsule ingestion. Small bowel cleansing was independently assessed by two experienced endoscopists and classified as poor, fair, good or excellent according to the proportion of small bowel mucosa under perfect conditions for visualization. When there was no agreement between the two endoscopists, the images were reviewed and discussed until a consensus was reached. The preparation was considered acceptable if > 50% or adequate if > 75% of the mucosa was in perfect cleansing condition. The amount of bubbles was assessed independently and it was considered significant if it prevented a correct interpretation of the images. Positive endoscopic findings, gastric emptying time (GET) and small bowel transit time (SBTT) were recorded for each examination. RESULTS:There was a trend favoring Group B in achieving an acceptable (including fair, good or excellent) level of cleansing (Group A: 65%; Group B: 83.3%; Group C: 68.4%) [P = not significant (NS)] and favoring Group C in attaining an excellent level of cleansing (Group A: 10%; Group B: 16.7%; Group C: 21.1%) (P = NS). The number of patients with an adequate cleansing of the small bowel, corresponding to an excellent or good classification, was 5 (25%) in Group A, 5 (27.8%) in Group B and 4 (21.1%) in Group C (P = 0.892). Conversely, 7 patients (35%) in Group A, 3 patients (16.7%) in Group B and 6 patients (31.6%) in Group C were considered to have poor small bowel cleansing (P = 0.417), with significant fluid or debris such that the examination was unreliable. The proportion of patients with a significant amount of bubbles was 50% in Group A, 27.8% in Group B and 15.8% in Group C (P = 0.065). This was significantly lower in Group C when compared to Group A (P = 0.026). The mean GET was 27.8 min for Group A, 27.2 min for Group B and 40.7 min for Group C (P = 0.381). The mean SBTT was 256.4 min for Group A, 256.1 min for Group B and 258.1 min for Group C (P = 0.998). Regarding to the rate of complete examinations, the capsule reached the cecum in 20 patients (100%) in Group A, 16 patients (88.9%) in Group B and 17 patients (89.5%) in Group C (P = 0.312). A definite diagnosis based on relevant small bowel endoscopic lesions was established in 60% of the patients in Group A (12 patients), 44.4% in Group B (8 patients) and 57.8% in Group C (11 patients) (P = 0.587). BRIEF ARTICLE

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Section: Discussionmentioning

confidence: 99%

Oral purgative and simethicone before small bowel capsule endoscopy

Rosa¹,

Barbosa²,

Magalhães³

et al. 2013

WJGE

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“…For intestinal preparation, it was observed that a comparative study carried out with NaP solution reported insufficient intestinal preparation rates as 18-20% (21,22). Studies related to the efficiency and safety of colonoscopy preparation in the elderly are limited.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of colonoscopy preparation with oral sodium phosphate in elderly patients

Yakut

Çınar²,

Seven³

et al. 2010

Turk J Gastroenterol

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“…Although electrolyte shifts are typically transient, clinically significant toxicities have been reported (Vanner et al, 1990). NaP preparations can also cause colonic mucosal abnormalities such as aphthoid erosions similar to those seen in inflammatory bowel disease and histologic findings including focal active inflammation, mucosal disruption and erosion, edema of the lamia propria, mucosal hyperemia, focal hemorrhage, lymphoid nodules and ulceration (Rejchrt et al, 2004). Physicians are advised to avoid using NaP preparations when evaluating patients with inflammatory bowel disease or patients with diarrhea of unknown etiology.…”

Section: Oral Sodium Phosphatementioning

confidence: 99%

“…Colonoscopic findings include aphthoid lesions, erosions and ulcers (Rejchrt et al, 2004). Histologically, focal nonspecific inflammation, mucosal erosion, edema of the lamina propria, focal hemorrhage, and ulceration are seen (Rejchrt et al, 2004).…”

Section: Possible Inflammatory Bowel Disease Ischemic Colitis or Nomentioning

confidence: 99%

“…In early studies, these mucosal changes were seen in more than 24% of patients who used NaP for bowel preparation (Zwas et al, 1996). More recent studies with a larger number of patients suggest that these changes occur in 3.3% of patients using these preparations (Rejchrt et al, 2004). Due to these potential mucosal changes, AGSE discourages the use of NaP as a bowel cleanser in the initial colonoscopy in patients with a suspicion of IBD (Anderson et al, 2009).…”

Section: Possible Inflammatory Bowel Disease Ischemic Colitis or Nomentioning

confidence: 99%

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Preparing for Colonoscopy

Deepak¹,

Sifuentes²,

Sherid³

et al. 2011

Endoscopic Procedures in Colon and Rectum

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Endoscopic Procedures in Colon and Rectum 18 followed by repeated procedures. In a study of 200 consecutive outpatient colonoscopies, imperfect bowel preparation resulted in a 12% increase in costs at a university hospital and 22% increase in costs at a public hospital (Rex et al., 2002). Types of bowel preparationsThe ideal colon preparation should rapidly and reliably cleanse the colon of fecal material while having no effect on the gross or microscopic appearance of the colon (Wexner et al., 2006). It should require a short period for ingestion and evacuation, cause no discomfort, and produce no significant fluid or electrolyte shifts while also being palatable, simple, and inexpensive. Agents used for bowel preparation can be divided into three main categories according to their mechanism of action, these being isosmotic, hyperosmotic, and adjunctive preparations. Polyethylene glycol-electrolyte lavage solutions (PEG-ELSs) and sodium phosphate (NaP) formulations are among the most commonly used. 2.2

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A prospective, observational study of colonic mucosal abnormalities associated with orally administered sodium phosphate for colon cleansing before colonoscopy

Cited by 78 publications

References 14 publications

Oral purgative and simethicone before small bowel capsule endoscopy

Oral purgative and simethicone before small bowel capsule endoscopy

The efficacy and safety of colonoscopy preparation with oral sodium phosphate in elderly patients

Preparing for Colonoscopy

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