SAFETY OF MANNITOL USE IN BOWEL PREPARATION: a prospective assessment of intestinal methane (CH4) levels during colonoscopy after mannitol and sodium phosphate (NaP) bowel cleansing

Abstract

-Background -Adequate bowel preparation is critical for the quality of colonoscopy. Despite reported occurrence of colonic explosion due to methane and hydrogen production by bacterial fermentation during colonoscopy, gas exchange during the procedure is believed to be effective in lowering existing methane concentration, allowing for safe utilization of mannitol for bowel preparation. Thus, mannitol is widely used for bowel cleansing prior to colonoscopy, considering its low cost and effectiveness for bowel preparation.

Factors influencing the presence of potentially explosive gases during colonoscopy: Results of the SATISFACTION study

“…So, the most likely interpretation is that this finding is due to insufficient gas exchange, and not to bowel cleansing with mannitol, and was caused by difficulties performing correct insufflation of the cecum during the colonoscopy. Air insufflation and suction used in routine colonoscopy should adequately dilute colonic gases to below dangerous levels, and electrocautery may be dangerous only within a pocket of undiluted intraluminal gas, as already reported in the literature 6,12,13 . This situation can occur irrespective of the drug used for bowel cleansing.…”

Pharmacokinetics of oral mannitol for bowel preparation for colonoscopy

“…It acts as an osmotic laxative and was widely used in the late 1970s and early 1980s as a bowel cleansing agent for colonoscopy. Currently, mannitol is commonly used, although off‐label, in some Latin America countries, especially in Brazil where it is still the most popular agent for bowel cleansing thanks to its effectiveness, high patient acceptance, and lack of significant systemic side effects 14 . In Europe and the United States, mannitol is currently not used due to some cases of intestinal explosion that, despite the absence of controlled clinical trials, have been attributed to a mannitol‐induced increase of methane (CH 4 ) and/or hydrogen (H 2 ) intestinal concentration during the execution of diathermy‐electrocautery or argon plasma coagulation 15 .…”

“…Currently, mannitol is commonly used, although off‐label, in some Latin America countries, especially in Brazil where it is still the most popular agent for bowel cleansing thanks to its effectiveness, high patient acceptance, and lack of significant systemic side effects. 14 In Europe and the United States, mannitol is currently not used due to some cases of intestinal explosion that, despite the absence of controlled clinical trials, have been attributed to a mannitol‐induced increase of methane (CH 4 ) and/or hydrogen (H 2 ) intestinal concentration during the execution of diathermy‐electrocautery or argon plasma coagulation. 15 However, other extremely rare cases of intestinal explosion were also reported in patients prepared for colonoscopy using a standard enema, 15 PEG, and sorbitol, 16 suggesting that the causes of the explosion may be other than the drug used for bowel cleansing.…”

Evaluation of pH and residual gastric volume after colon preparation with mannitol: prospective randomized study comparing procedure performed after 3 hours versus 6 hours

“…Along with appropriate timing of administration, bowel preparations need to be safe, palatable, and efficacious (2). Mannitol is a hyperosmolar liquid reported to be comparatively effective and well-tolerated as polyethylene glycol (PEG) and oral sodium phosphate (OSP) (7)(8)(9)(10). Healthcare providers in Brazil and other parts of the world extensively administer mannitol due to its effective bowel cleansing, better tolerance, low complication rates, and low costs (8)(9)(10)(11).…”