Diabetics on Narcotics Are Less Likely to Achieve Excellent Bowel Preparation Than Are Patients with Either Condition

Madhoun, Mohammad F.; Bitar, Hussein; Bhatti, Owais; Zia, Hassaan; Parava, Pratyusha; Bashir, Muhammad H.

doi:10.1007/s10620-016-4417-6

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…Due to dietary/medication regimen changes, narcotic use, and diabetes-related complications/comorbidities such as hypoglycemia, electrolyte imbalance, acute renal failure, and ketoacidosis, diabetic patients are at risk of poor bowel preparation[ 82 , 83 ].…”

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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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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show abstract

“…Need for colonoscopy is common in patients with DM, given the high prevalence of gastrointestinal symptoms and a possible increased risk of colon cancer 11 12 . Previous studies suggested that the rate of inadequate bowel preparation ranged between 20 % and 38 % in patients with diabetes 13 14 15 16 .…”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerability of various bowel preparations in diabetic patients: a randomized controlled trial

et al. 2018

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Background and study aims Diabetes mellitus (DM) is an independent risk factor for poor bowel preparation prior to colonoscopy. Bisacodyl is a stimulant laxative that may mitigate colonic dysmotility associated with diabetes. We hypothesized that adding bisacodyl to split-dose bowel preparation (SDBP) would improve the quality of bowel preparation among patients with diabetes. Patients and methods Adult outpatients aged 18 to 80 years undergoing colonoscopy were recruited. One hundred and eighty-six patients with diabetes were randomly assigned to 1 of 3 treatment arms: 1) conventional 4 L of polyethylene glycol electrolyte lavage solution (PEG-ELS; conventional bowel preparation [CBP]); 2) split-dose of 4 L PEG-ELS (split-dose bowel preparation [SDBP]); or 3) split-dose of 4 L PEG-ELS preceded by 10 mg of oral bisacodyl 10 (SDBP-B). The primary outcome measure was bowel cleansing as indicated by Boston Bowel Preparation Scale (BBPS) score. Endoscopists were blinded to the preparation used. Secondary outcome measures were safety and patient tolerability. Results Of the 212 patients randomized, only 186 received assigned bowel preparation. There were no differences among the three study groups with regard to age, indication, duration of DM, insulin use, narcotic use, or presence of end-organ diabetic complications. There was a trend toward better bowel preparation quality among those receiving SDBP and SDBP-B compared to those receiving CBP, but the trend was not statistically significant ≥ 6 BBPS; 67 % vs. 83 % vs. 75 %, P = 0.1). In terms of safety and tolerability, there were no differences among the three groups. Conclusion Adding bisacodyl to SDBP does not improve the quality of bowel preparation in patients with DM. Further efforts are needed to optimize colonoscopy bowel preparation in this population.

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“…No serious adverse events were observed. The study did not provide information on the occurrence of hypoglycaemic episodes [ 26 ].…”

Section: Methods Of Mitigating the Risk Of Hypoglycaemia And Metabolic Disordersmentioning

confidence: 99%

“…The authors of the study suggested that patients with more than 1 risk factor for poorer bowel cleansing should receive special care at the stage of preparation for colonoscopy. The authors also pointed to the need to adapt the preparatory procedures to the individual needs of a person referred for this examination [ 26 ].…”

Section: Effectiveness Of Colonoscopy Preparation Procedures In the Diabetic Patient Populationmentioning

confidence: 99%

Preparation for endoscopic examinations in patients with diabetes and hypoglycaemia

Lewandowski¹,

Rydzewska²,

Ledwoń³

2021

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Endoscopy is a procedure used for diagnostic and therapeutic purposes, which requires proper preparation. Patients with diabetes mellitus are particularly predisposed to inadequate cleansing for endoscopy due to slowing bowel movements, dietary preparation restrictions, glucose reduction, and the resulting symptoms of hypoglycaemia. So far, no comprehensive guidelines of preparation for endoscopic examinations for patients with these metabolic disorders have been developed. Considering the number of patients who may be subjected to colonoscopy and the possible effects of suboptimal preparation for the examination, the lack of such recommendations seems to be a significant gap in the healthcare system. The article reviews the literature on the above topic.

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Diabetics on Narcotics Are Less Likely to Achieve Excellent Bowel Preparation Than Are Patients with Either Condition

Abstract: Concomitant narcotic use and diabetes have a compounding effect on the quality of bowel preparation prior to colonoscopy.

Cited by 6 publications

References 29 publications

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

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

Efficacy and tolerability of various bowel preparations in diabetic patients: a randomized controlled trial

Preparation for endoscopic examinations in patients with diabetes and hypoglycaemia

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