A Randomized Controlled Trial Comparing Colonoscopic Enema With Additional Oral Preparation as a Salvage for Inadequate Bowel Cleansing Before Colonoscopy

Yang, Hyo‐Joon; Park, Dong Il; Park, Soo-Kyung; Kim, Sunyong; Lee, Taeheon; Jung, Yunho; Eun, Chang Soo; Han, Dong Soo

doi:10.1097/mcg.0000000000001087

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…On the other hand, a randomized trial compared 1 L PEG enema administered through the colonoscope to the additional oral ingestion of 2 L PEG in 125 patients with inadequate preparation. An appropriate preparation was obtained in 35 out of 66 (53 %) in the enema group vs. 53 out of 67 (81 %) in the oral group, with respective Boston Bowel Preparation Scale scores of 6.3 vs. 7.4 (P < 0.001) [188].…”

Section: Direct Enema or Irrigationmentioning

confidence: 92%

Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

et al. 2019

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Main RecommendationsESGE recommends a low fiber diet on the day preceding colonoscopy.Strong recommendation, moderate quality evidence.ESGE recommends the use of enhanced instructions for bowel preparation.Strong recommendation, moderate quality evidence.ESGE suggests adding oral simethicone to bowel preparation.Weak recommendation, moderate quality evidence.ESGE recommends split-dose bowel preparation for elective colonoscopy.Strong recommendation, high quality evidence.ESGE recommends, for patients undergoing afternoon colonoscopy, a same-day bowel preparation as an acceptable alternative to split dosing.Strong recommendation, high quality evidence.ESGE recommends to start the last dose of bowel preparation within 5 hours of colonoscopy, and to complete it at least 2 hours before the beginning of the procedure.Strong recommendation, moderate quality evidence.ESGE recommends the use of high volume or low volume PEG-based regimens as well as that of non-PEG-based agents that have been clinically validated for routine bowel preparation. In patients at risk for hydroelectrolyte disturbances, the choice of laxative should be individualized.Strong recommendation, moderate quality evidence.

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Section: Direct Enema or Irrigationmentioning

confidence: 92%

Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

et al. 2019

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“…Yang et al [ 157 ] on the other hand, conducted a randomized trial in 125 patients with inadequate preparation, comparing administration of a 1-L PEG enema via colonoscope to additional oral ingestion of 2-L PEG, with 35 of 66 (53%) of the enema group and 53 of 67 (81%) of the oral group obtaining suitable preparation. 42 patients with inadequate preparation were randomly assigned to either pump irrigation or syringe irrigation in a 2012 Belgian monocenter study.…”

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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“…There are some experiences using this type of strategy. Yang et al randomized 131 patients with poor bowel preparation (BBPS of < 2 in at least one segment) to a 1 L PEG enema administered through the colonoscopy channel in the right colon or 2 L of oral PEG plus ascorbic acid during same day of the examination [11]. The additional oral solution managed to rescue up to 81% of the patients compared to 50% with the enema administration (p < 0.001).…”

Section: Rescue Strategiesmentioning

confidence: 99%

“…Conversely, educational interventions could be useful when deficient adherence to preparation instructions surfaces as the chief concern [10]. As a final recourse, rescue cleansing strategies have been used [11]. Notably, recent advancements have incorporated artificial-intelligence-driven devices for guiding bowel preparation, and they have exhibited promising outcomes [12].…”

Section: Introductionmentioning

confidence: 99%

Colon Bowel Preparation in the Era of Artificial Intelligence: Is There Potential for Enhancing Colon Bowel Cleansing?

Gimeno-García,

Benítez-Zafra,

Nicolás-Pérez

et al. 2023

Medicina

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Background and Objectives: Proper bowel preparation is of paramount importance for enhancing adenoma detection rates and reducing postcolonoscopic colorectal cancer risk. Despite recommendations from gastroenterology societies regarding the optimal rates of successful bowel preparation, these guidelines are frequently unmet. Various approaches have been employed to enhance the rates of successful bowel preparation, yet the quality of cleansing remains suboptimal. Intensive bowel preparation techniques, supplementary administration of bowel solutions, and educational interventions aimed at improving patient adherence to instructions have been commonly utilized, particularly among patients at a high risk of inadequate bowel preparation. Expedited strategies conducted on the same day as the procedure have also been endorsed by scientific organizations. More recently, the utilization of artificial intelligence (AI) has emerged for the preprocedural detection of inadequate bowel preparation, holding the potential to guide the preparation process immediately preceding colonoscopy. This manuscript comprehensively reviews the current strategies employed to optimize bowel cleansing, with a specific focus on patients with elevated risks for inadequate bowel preparation. Additionally, the prospective role of AI in this context is thoroughly examined. Conclusions: While a majority of outpatients may achieve cleanliness with standard cleansing protocols, dealing with hard-to-prepare patients remains a challenge. Rescue strategies based on AI are promising, but such evidence remains limited. To ensure proper bowel cleansing, a combination of strategies should be performed.

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A Randomized Controlled Trial Comparing Colonoscopic Enema With Additional Oral Preparation as a Salvage for Inadequate Bowel Cleansing Before Colonoscopy

Abstract: The colonoscopic enema of 1 L PEG was inferior to the additional oral ingestion of 2 L PEG regarding efficacy as a salvage bowel preparation in adults with inadequate bowel cleansing for colonoscopy.

Cited by 8 publications

References 25 publications

Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

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

Colon Bowel Preparation in the Era of Artificial Intelligence: Is There Potential for Enhancing Colon Bowel Cleansing?

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