The unmet needs for identifying the ideal bowel preparation

Tontini, Gian Eugenio; Prada, Alberto; Sferrazza, Sandro; Ciprandi, Giorgio; Vecchi, Maurizio

doi:10.1002/jgh3.12653

Cited by 14 publications

(13 citation statements)

References 77 publications

(139 reference statements)

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“…Adequacy of bowel preparation depends on different factors, either related to the patient or to the preparation itself [5,6]. Among factors related to the cleansing products, volume of preparation, and the modality of assumption are particularly relevant.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for inadequate bowel preparation in patients using high- and low-volume cleansing products

Occhipinti

Soriani

Vavassori

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Introduction Bowel preparation is crucial for colonoscopy completeness and lesions detection. Today, several cleansing products are equally recommended by guidelines, irrespective of patients’ characteristics. Identification of preparation-specific risk factors for inadequate bowel preparation may lead to a personalized prescription of cleansing products to refine patients’ tolerance and improve endoscopic outcomes. Methods We prospectively enrolled consecutive outpatients referred for colonoscopy using either a high-volume [HV: 4 l polyethylene glycol (PEG)] or a low-volume (LV: 2 l PEG + bisacodyl) preparation. Day-before regimen or split-dose regimen was used for morning or afternoon colonoscopies, respectively. Univariate and multivariate analyses were conducted to identify risk factors related to inadequate bowel preparation, according to the Boston bowel preparation scale for HV and LV preparations. Results We enrolled 2040 patients, of which 1815 were included in the final analysis (average age 60.6 years, 50.2% men). Half of them (52%) used LV preparation. Adequate preparation was achieved by 87.6% without differences between the HV and LV groups (89.2% vs. 86.6%; P = 0.098). The use of day-before regimen and incomplete assumption of PEG were independent predictors of poor visibility for either HV or LV preparation. However, different specific risk factors for HV [diabetes: odds ratio (OR), 3.81; 95% confidence interval (CI), 1.91–7.58; low level of instruction: OR, 1.95; 95% CI, 1.11–3.44; and previous abdominal surgery: OR, 2.27; 95% CI, 1.20–4.30] and for LV (heart disease: OR, 2.06; 95% CI, 1.09–3.88; age > 65 years: OR, 1.51; 95% CI, 1.01–2.27) preparations were identified. Conclusion Day-before preparation and incomplete assumption of the purgative agents affect bowel visibility irrespective of the preparation volume. LV should be preferred to HV preparations in patients with diabetes, low level of instruction, and previous abdominal surgery, whereas an HV preparation should be preferred in patients with heart disease and in older patients.

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Section: Discussionmentioning

confidence: 99%

“…Today, however, international guidelines [4,5] recommend different types of bowel preparations, without indicating specific recommendations to guide physicians on which one to choose. The main distinction among the different products is the volume of liquids to be assumed by the patient [6].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for inadequate bowel preparation in patients using high- and low-volume cleansing products

Occhipinti

Soriani

Vavassori

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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“…Die optimale Vorbereitung von Diabetes-Patienten vor einer Koloskopie gibt es nicht "von der Stange". Sie erfüllt vielmehr die Kriterien einer personalisierten Medizin [31]…”

Section: Konzepte Zur Darmvorbereitung Vor Koloskopieunclassified

Koloskopievorbereitung bei Patienten mit Diabetes mellitus: Entwicklung einer Handlungsempfehlung

2022

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Zusammenfassung Hintergrund Der Schlüsselfaktor für die Aussagekraft einer Koloskopie ist die Qualität der Darmvorbereitung (Kolonlavage). Eine schlechte Darmvorbereitung führt zu verlängerten Untersuchungszeiten, inkompletten Untersuchungen und erhöht das Komplikationsrisiko. Eine Diabeteserkrankung ist ein bedeutender Risikofaktor für eine insuffiziente Kolonlavage. Standardisierte Empfehlungen zur Koloskopievorbereitung von Diabetespatienten liegen bisher nicht vor. Methode Es erfolgte eine selektive Literatursuche in PubMed und GoogleScholar bis einschließlich 06/2021. Leitlinien und Positionspapiere der deutschen, europäischen und amerikanischen Fachgesellschaften sowie klinikeigene Erfahrungen wurden ebenfalls berücksichtigt. Ergebnisse Für die Darmvorbereitung gibt es verschiedene Wirkstoffe, die in 2 Hauptgruppen aufgeteilt werden können: Polyethylenglycol (PEG)-Lösungen und osmotische Lösungen. Es liegen inzwischen eine Reihe von Metaanalysen vor, die Unterschiede in den verschiedenen Vorbereitungsschemata untersucht haben. Die Ergebnisse sind sehr heterogen. Neben der Wahl des Abführmittels und der Frage welcher Zeitpunkt der Einnahme günstig ist, scheint die Art der Aufklärung zur Darmvorbereitung eine entscheidende Rolle zu spielen. Außerdem ist bei Diabetes-Patienten die Ernährung in den Tagen vor der Koloskopie von besonderer Bedeutung. Schlussfolgerung PEG-basierte Abführlösungen in Split-Dosis sind bei Diabetes-Patienten aufgrund der häufig vorliegenden Motilitätsstörungen zu bevorzugen. Eine subtile Aufklärung über die Abführmaßnahmen und ein individueller Ernährungsplan für die Tage vor der Koloskopie werden empfohlen.

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“…Several factors such as the institutional cadre, personnel, hospital stay length, patient characteristics, and bowel preparation efficiency can affect the outcomes of colonoscopy. 12 Adequate bowel preparation is one of the most important requirements for achieving high-quality colonoscopic findings. Many studies have reported that a considerably higher proportion of patients undergoing colonoscopy have inadequate bowel preparation.…”

Section: Introductionmentioning

confidence: 99%

Effect of Bowel Preparation to Colonoscopy Interval on Preparation Quality and Colonoscopy Outcomes: A Meta-Analysis

Gao¹,

Lin²

2023

Turk J Gastroenterol

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Background: This study evaluates the effect of bowel preparation to colonoscopy time interval on quality of bowel preparation and outcomes of colonoscopy. Methods: Studies were identified after a literature search in electronic databases and were selected for inclusion based on precise eligibility criteria. Meta-analyses of proportions were performed to achieve overall bowel preparation adequacy and adenoma/polyp detection rates. Odds ratios depicting associations between bowel preparation quality and bowel preparation to colonoscopy time were pooled to achieve an overall estimate. Results: Twenty studies (10 341 individuals subjected to colonoscopy) were included. Bowel preparation adequacy rate was higher with shorter (94% [95% CI: 91, 97]) than with longer (84% [95% CI: 79, 89]) interval between bowel preparation and colonoscopy. In a subgroup analysis, <5, 6-10, 11-20, and >20 hours intervals were associated with 94% [95% CI: 92, 97], 92% [95% CI: 86, 96], 85% [95% CI: 77, 91], and 85% [95% CI: 75, 92] adequacy rates, respectively. A pooled analysis of odds ratios also showed that bowel preparations adequacy was significantly better with shorter bowel preparation to colonoscopy time (odds ratio 1.69 [95% CI: 1.23, 2.15]). There was no significant difference in adenoma detection rate between shorter (18% [95% CI: 9, 29]) and longer (19% [95% CI: 15, 22]) bowel preparation to colonoscopy intervals. Polyp detection rate was higher with shorter (47% [95% CI: 27, 68]) than with longer (30% [95% CI: 24, 38]) bowel preparation to colonoscopy interval. Conclusion: A shorter interval between bowel preparation and colonoscopy led to a higher bowel preparation adequacy rate which was also associated with a higher polyp detection rate.

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The unmet needs for identifying the ideal bowel preparation

Cited by 14 publications

References 77 publications

Risk factors for inadequate bowel preparation in patients using high- and low-volume cleansing products

Risk factors for inadequate bowel preparation in patients using high- and low-volume cleansing products

Koloskopievorbereitung bei Patienten mit Diabetes mellitus: Entwicklung einer Handlungsempfehlung

Effect of Bowel Preparation to Colonoscopy Interval on Preparation Quality and Colonoscopy Outcomes: A Meta-Analysis

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