Polyethylene glycol plus bisacodyl: A safe, cheap, and effective regimen for colonoscopy in the South Asian patients

Jha, Ashish K.; Chaudhary, Madhur; Jha, Praveen; Kumar, Upendra; Dayal, Vishwa Mohan; Jha, Sharad Kumar; Purkayastha, Shubham; Ranjan, Ravish; Mishra, Manish; Sehrawat, Kuldeep

doi:10.1002/jgh3.12077

Cited by 6 publications

(8 citation statements)

References 28 publications

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“…Usual indications for colonoscopy in South Asia are gastrointestinal bleeding, abdominal pain and altered bowel habit caused by infective colitis, inflammatory bowel disease, ileocecal tuberculosis, hemorrhoids, and malignancies. [10] South Asian populations have lower body mass index, different diet habits, and shorter colonic transit time compared to Western countries. Studies from India had shown that adequate preparation for late-morning/afternoon colonoscopy can be achieved with the use of low-volume PEG-ELS with or without stimulant laxatives.…”

Section: Polyethylenementioning

confidence: 99%

“…Studies showed similar efficacy of a regimen of stimulant laxative at bedtime with 2L PEG-ELS in the morning and a 4L PEG-ELS split-dose regimen. [9,10] In a meta-analysis of six randomized controlled trials, low-volume PEG (2L) with bisacodyl demonstrates similar rates of adequate bowel cleansing and less nausea, vomiting, and bloating compared to 4L split-dose PEG-ELS. [9] In addition, the use of 2L PEG-ELS plus bisacodyl can save approximately $6 per procedure.…”

Section: Polyethylenementioning

confidence: 99%

“…[9] In addition, the use of 2L PEG-ELS plus bisacodyl can save approximately $6 per procedure. [10] The average daily per capita income in South Asia is approximately $5. Recently, the US FDA has approved Prepopik, a powder mixture of sodium picosulfate, magnesium oxide, and citric acid, for colonoscopy preparation.…”

Section: Polyethylenementioning

confidence: 99%

“…Studies from India had shown that adequate preparation for late-morning/afternoon colonoscopy can be achieved with the use of low-volume PEG-ELS with or without stimulant laxatives. [10,11] Low-volume cleansing agents with or without an adjunct are gaining mainstream acceptance for bowel preparation due to reduced volume and acceptable safety profile. In the current issue, Bowel Cleansing agents in Clinical Practice: 'A Cross-Sectional study on Safety, Efficacy, and Predictor of Good Bowel Preparation' by Joshi et al, [12] the authors showed better efficacy and comparable safety profile of low-volume OSS compared to PEG-ELS regimen for bowel preparation for colonoscopy in Indian population.…”

Section: Polyethylenementioning

confidence: 99%

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How Effective are Low-Volume Solutions for Oral Colonoscopy Bowel Preparation?

Jha

2019

Journal of Digestive Endoscopy

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preparation, and adverse events. [2] A split-dose regimen of 4L PEG-ELS is endorsed by the American College of Gastroenterology as an optimal choice for colonoscopy. However, approximately 5%-15% of the patients are poorly tolerating PEG-ELS, mostly due to large-volume PEG-ELS ingestion. Large-volume PEG-ELS can cause abdominal fullness, bloating, cramping, nausea, vomiting, and insomnia. Aspiration pneumonia, colitis, pancreatitis, and Mallory-Weiss tears are other rare complications of large-volume regimen.This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. EditorialHow to cite this article: Jha AK. How effective are low-volume solutions for oral colonoscopy bowel preparation? J Dig Endosc 2019;XX:XX-XX.

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Section: Polyethylenementioning

confidence: 99%

Section: Polyethylenementioning

confidence: 99%

Section: Polyethylenementioning

confidence: 99%

Section: Polyethylenementioning

confidence: 99%

See 2 more Smart Citations

How Effective are Low-Volume Solutions for Oral Colonoscopy Bowel Preparation?

Jha

2019

Journal of Digestive Endoscopy

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“…The adequacy of bowel cleansing mainly depends on the type of cleansing agents, volume of preparation, mode of administration (single dose vs. split dose, single day vs. two days), use of adjunct agents, the preparation-to-colonoscopy interval, and associated comorbidities in patients. 1,2 Other factors for adequate bowel cleansing may include low residue diet, liberal fluid intake, and proper bowel preparation instructions.…”

mentioning

confidence: 99%

Oral Sulfate Solution for Precolonoscopy Bowel Preparation: A New Kid on the Block

Jha

2019

Journal of Digestive Endoscopy

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J Digest Endosc 2019;10:178-179 single-dose regimens. Introduction of oral phosphate and sulfate salts offered the advantage of low intake volume, low risk of gastrointestinal irritation, and less volume-related adverse events compared with other available options. Oral phosphate salts have been associated with acute phosphate nephropathy, and rarely chronic renal damage. Oral sulfate salts (OSSs) have recently been approved for precolonoscopy bowel cleansing. Because sulfate absorption from the intestinal tract is saturable, serum sulfate concentrations increase only minimally after ingestion. Excretion of OSS in the kidney is not accompanied by calcium excretion and acute phosphate nephropathy. Use of OSS has not been associated with clinical manifestations of kidney injury but clinically nonsignificant serum electrolyte disturbances. 5 Studies have shown that OSS is a safe and effective bowel cleansing agent for colonoscopy. The efficacy of OSS in cleansing the colon ranges from 82 to 98%. [6][7][8][9] Studies have shown better efficacy and comparable adverse events profile of split-dose OSS regimen compared with split-dose PEG solution regardless of dose. In a study, OSS subjects reported slightly increased gastrointestinal events (abdominal distension, pain, nausea, vomiting, or abdominal discomfort) (p = 0.009) in the single-day preparation but not in the split-dose OSS regimen. 7 Colonoscopy preparation using split-dose low-volume OSS appears to be cost-effective compared with PEG-ELS with a cost saving of $16.01 per patient per year for the OSS cohort. 10 It is worth mentioning that data are available regarding the usefulness of OSS as a bowel cleansing agent for colonoscopy; however, most of the studies were performed on outdoor patients. Data regarding the efficacy and safety of OSS in the elderly patients with or without comorbidities and hospitalized patients are very limited.In the current issue, "Oral sulfate solution versus polyethylene glycol as a single day preparation for colonoscopy: a randomized control trial" by Shah et al 11 showed superior efficacy and comparable adverse events profile of OSS compared with PEG regimen for bowel preparation for colonoscopy. However, the adequate bowel cleansing was achieved Colonoscopy is a widely used procedure which requires prior cleansing of the bowel. Optimal bowel cleansing is essential for a successful and accurate examination of the bowel. Inadequate bowel cleansing during colonoscopy can result in missed lesions, difficult and incomplete procedures, prolonged cecal intubation time, and increased risk of procedural complications. The adequacy of bowel cleansing mainly depends on the type of cleansing agents, volume of preparation, mode of administration (single dose vs. split dose, single day vs. two days), use of adjunct agents, the preparation-to-colonoscopy interval, and associated comorbidities in patients. 1,2 Other factors for adequate bowel cleansing may include low residue diet, liberal fluid intake, and proper bowel preparation instruct...

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