A Retrospective Case-Control Study Evaluating the Bowel Preparation Quality during Surveillance Colonoscopy after Colonic Resection

Abstract

Purpose. Bowel preparation for surveillance endoscopy following surgery can be impaired by suboptimal bowel function. Our study compares two groups of patients in order to evaluate the influence of colorectal resection on bowel preparation. Methods. From April 2010 to December 2011, 351 patients were enrolled in our retrospective study and divided into two homogeneous arms: resection group (RG) and control group. Surgical methods were classified as left hemicolectomy, right hemicolectomy, anterior rectal resection, and double colonic resection. Bowel cleansing was evaluated by nine skilled endoscopists using the Aronchick scale. Results. Among the 161 patients of the RG, surgery was as follows: 60 left hemicolectomies (37%), 62 right hemicolectomies (38%), and 33 anterior rectal resections (20%). Unsatisfactory bowel preparation was significantly higher in resected population (44% versus 12%; P value = 0.000). No significant difference (38% versus 31%, P value = ns) was detected in the intermediate score, which represents a fair quality of bowel preparation. Conclusions. Our study highlights how patients with previous colonic resection are at high risk for a worse bowel preparation. Currently, the intestinal cleansing carried out by 4 L PEG based preparation does not seem to be sufficient to achieve the quality parameters required for the post-resection endoscopic monitoring.

Novel frontiers of agents for bowel cleansing for colonoscopy

“…In fact, the study performed by Lim et al [ 160 ] is the first one demonstrating that the percentage of inadequate BP is higher in the resection group (gastric or colonic resection) than in the control group. This data was confirmed by Pontone et al [ 161 ] using the same cleaning agent (4 L PEG).…”

Split‐dose 4‐L polyethylene glycol regimen for patients with previous colorectal surgery in bowel preparation before colonoscopy: A randomized, controlled, single‐blind study

“…Third, surgery‐related factors including a history of other abdominal surgery, the classification of colorectal resection and type of surgery had a limited impact on bowel preparation quality in our study. Although ileocecal valve resection or end‐to‐side anastomosis and postoperative duration were potential factors related to unsuccessful bowel preparation in the univariate analysis, this relationship was not found in the multivariate analysis, which confirmed the small effect of the ileocecal valve on the transit of solid contents …”

“…Although ileocecal valve resection or end-to-side anastomosis and postoperative duration were potential factors related to unsuccessful bowel preparation in the univariate analysis, this relationship was not found in the multivariate analysis, which confirmed the small effect of the ileocecal valve on the transit of solid contents. 15,38 Our study had several notable advantages. First, this work was the first prospective study to propose a suitable, enhanced bowel preparation regimen for patients with previous colorectal surgery in an Asian population.…”

“…5 While a 2-L PEG regimen alone in the absence of any additional laxatives such as ascorbic acid or bisacodyl is recommended in some Asian countries (e.g., China, Japan, India and Singapore), [7][8][9][10][11][12][13][14] possibly because the Asian populations tend to have a smaller body type and a worse tolerance to the bowel preparation regimen. Colorectal surgery is an independent predictive factor for inadequate bowel preparation, [15][16][17] and the 2-L PEG regimen has not achieved satisfactory bowel preparation results in clinical practice in patients with a history of previous colorectal surgery. The dose of PEG is a key factor that affects the quality of bowel preparation, 8,9 and a 4-L PEG regimen has been reported to be sufficient for improving the quality of bowel preparation in such patients.…”