The Timing of Bowel Preparation Is More Important than the Timing of Colonoscopy in Determining the Quality of Bowel Cleansing

Abstract Introduction Smartphone-based applications (apps) have been used to improve the quality of bowel preparation (prep) but the success rates have been variable. We have performed a systematic review and meta-analysis to evaluate the impact of smartphone apps on bowel preparation. Methods Electronic databases (MEDLINE, Embase, CINAHL and Cochrane) were reviewed for eligible studies of smartphone apps versus standard education before colonoscopy. The following outcomes were analyzed: pooled rate of adequacy of bowel prep among both arms and Boston bowel preparation score (BBPS) when reported. Pooled analysis was reported as odds ratio (OR) or mean difference in random effect model with Review Manager 5.3 (P ≤ 0.05 for statistical significance). Results Six studies were eligible with smartphone app (810 patients) vs. standard education (855 patients, control group) for bowel prep. The smartphone app group had a higher proportion of adequate bowel prep compared to the control group: 87.5 % vs 77.5 % (five studies), pooled OR 2.67; 95 %CI 1.00 – 7.13 with P = 0.05. There was substantial heterogeneity in studies with I 2 = 78 %. When analysis was limited to randomized controlled trials (RCTs), smartphone app users had a numerically higher rate of bowel cleansing: 87.1 % vs 76.9 %; however, pooled OR was not statistically significant (OR 2.66, 95 %CI 0.92 – 7.69, P = 0.07). When studies using BBPS were evaluated (n = 3), smartphone app users had higher mean scores (better bowel prep) with a mean difference of 0.9 (95 %CI 0.5 – 1.3), which was statistically significant (P < 0.01). Conclusion The smartphone app is a novel educational tool that can assist in achieving adequate and better bowel cleansing before colonoscopy.

Download Full-text

A modified bowel preparation protocol improves the quality of bowel cleansing for colonoscopy

Advances in Digestive Medicine ◽

10.1016/j.aidm.2015.12.001 ◽

2016 ◽

Vol 3 (3) ◽

pp. 144-147 ◽

Cited By ~ 2

Author(s):

Wei-Fan Hsu ◽

Cheng-Chao Liang ◽

Cheng-Kuan Lin ◽

Tzong-Hsi Lee ◽

Chen-Shuan Chung

Keyword(s):

Bowel Preparation ◽

Bowel Cleansing

Download Full-text

A NEW AGENT BOWEL CLEANSING BEFORE ENDOSCOPY - «COLOKIT»

Koloproktologia ◽

10.33878/2073-7556-2019-18-2-27-32 ◽

2019 ◽

Vol 18 (2) ◽

pp. 27-32

Author(s):

A. V. Galyaev ◽

V. V. Veselov ◽

R. I. Romanov ◽

E. A. Poltorykhina ◽

O. S. Ozerova

Keyword(s):

Bowel Preparation ◽

Drug Tolerance ◽

Subjective Assessment ◽

Diagnostic Colonoscopy ◽

Randomised Study ◽

Bowel Cleansing ◽

Good Preparation ◽

Alternative Regime

AIM: to evaluate the efficacy, safety and drug tolerance of «Colokit» for bowel cleansing before colonoscopy.PATIENTS AND METHODS: an open prospective non-randomised study of the quality of bowel cleansing was carried out in 30 patients (17 females, aged 26-72 years), who underwent diagnostic colonoscopy after using «Сolokit» (Mayoly Spindler, France) using two different regimes (recommended and alternative).RESULTS: the quality of the bowel cleansing was significantly better in patients after «Colokit» use in recommended regime vs alternative regime. No difference in subjective assessment of patients’ comfort during bowel preparation was found in both regimes. CONCLUSION: the «Colokit» agent provides good preparation and patients’ comfort and can be recommended for the bowel cleansing before colonoscopy.

Download Full-text

NEW BOWEL PREPARATION TECHNIQUE FOR COLONOSCOPY: CLINICAL TRIAL COMPARING AQUANET AND MANNITOL

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020180001e1393 ◽

2018 ◽

Vol 31 (3) ◽

Cited By ~ 1

Author(s):

Roberto Luiz KAISER-JÚNIOR ◽

Luiz Gustavo DE-QUADROS ◽

Mário FLAMINI-JÚNIOR ◽

Mikaell Alexandre Gouvea FARIA ◽

Juan Carlos Ochoa CAMPO ◽

...

Keyword(s):

Bowel Preparation ◽

The Other ◽

Preparation Technique ◽

Prospective Longitudinal Study ◽

Mannitol Solution ◽

Bowel Cleansing ◽

Solution Methods ◽

Prospective Longitudinal ◽

Intestinal Preparation

ABSTRACT Background: Fifty-five percent of Americans aged 50-65 are submitted to colonoscopy. For over 65-year, this number increases to 64%. In Brazil, it is forecast that the population submitted to colonoscopy will grow, even though inadequate preparation is still a major problem. Aim: To analyze the quality of a new intestinal preparation technique, Aquanet EC-2000®, compared to oral Mannitol solution. Methods: This prospective longitudinal study enrolled 200 patients with indication for colonoscopy. The sample was randomly allocated to two groups of 100; one group received Aquanet EC-2000® to prepare for colonoscopy and the other Mannitol solution. The Boston scale was used to analyze the results. Results: As expected both preparations produced similar results with the bowel cleansing of the different regions of the colon being classified as Boston scale 3 (excellent) in most patients (p>0.05). Conclusion: The results of bowel preparation using Aquanet EC-2000® were similar to using Mannitol solution.

Download Full-text

Comparison of Polyethylene Glycol versus Lactulose Oral Solution for Bowel Preparation prior to Colonoscopy

Gastroenterology Research and Practice ◽

10.1155/2019/2651450 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Chun-Xia Li ◽

Yan Guo ◽

Yang-Jie Zhu ◽

Jian-Ru Zhu ◽

Qian-Song Xiao ◽

...

Keyword(s):

Polyethylene Glycol ◽

Bowel Preparation ◽

Oral Solution ◽

Physician Satisfaction ◽

Detection Rates ◽

Bowel Cleansing ◽

Degree Of Satisfaction ◽

Bowel Preparations ◽

Colonoscopy Preparation

Objective. This study was conducted to compare a lactulose oral solution with a polyethylene glycol (PEG) formulation for colonoscopy preparation using the following metrics: quality of cleansing, colonoscopy outcomes, patient/physician satisfaction, and patient tolerability. Methods. The enrolled patients were randomly divided into two groups and received a single 2 L dose of either PEG (PEG group) or lactulose (Lac group). The Boston Bowel Preparation Scale (BBPS) was used for assessing the cleansing quality of the bowel preparations. Patient tolerability and adverse events were obtained through the completion of questionnaires. Results. The lactulose oral solution showed superior bowel cleansing compared to PEG, as evidenced by higher BBPS scores in the Lac group for all segments of the colon (P<0.05). The detection rates of polyps and intestinal lesions in the Lac group (30.68% and 36.36%, respectively) were significantly higher than those in the PEG group (12.50% vs. 13.63%, respectively). For the degree of satisfaction, the Lac group had significantly higher scores compared to the PEG group, as evaluated by both the patients and endoscopist. PEG was associated with an increased incidence of nausea. There were no statistical differences between the groups in terms of vomiting, abdominal pain or fullness, dizziness, unfavorable palatability, dry mouth, palpitation, tinnitus, and tongue numbness. Conclusion. A single 2 L dose of a lactulose oral solution had higher efficacy, improved tolerability, and acceptable safety for bowel preparation when compared to the same volume of PEG. Thus, a lactulose oral solution may be a potential bowel-cleansing option for colonoscopy preparation.

Download Full-text

Preparation regimen is more important than patient-related factors: a randomized trial comparing a standard bowel preparation before colonoscopy with an individualized approach

Romanian Journal of Internal Medicine ◽

10.1515/rjim-2016-0047 ◽

2017 ◽

Vol 55 (1) ◽

pp. 36-43 ◽

Cited By ~ 1

Author(s):

T. Voiosu ◽

Alina Tanţău ◽

A. Voiosu ◽

Andreea Benguş ◽

Cristina Mocanu ◽

...

Keyword(s):

Polyethylene Glycol ◽

Bowel Preparation ◽

Multivariable Analysis ◽

Standard Group ◽

Related Factors ◽

Split Dose ◽

Bowel Cleansing ◽

Significant Difference ◽

Bowel Prep

Abstract Background. Optimal bowel preparation is one of the most important factors affecting the quality of colonoscopy. Several patient-related factors are known to influence the quality of bowel cleansing but randomized trials in this area are lacking. We aimed to compare an individualized bowel prep strategy based on patient characteristics to a standard preparation regimen. Material and Methods. We conducted an endoscopist-blinded multicenter randomized control-trial. The Boston Bowel Prep Score (BBPS) was used to assess quality of bowel preparation and a 10 point visual analogue scale to assess patient comfort during bowel prep. Patients were randomised to either the standard regimens of split-dose 4L polyethylene-glycol (group A), split-dose sodium picosulphate/magnesium citrate (group B) or to either of the two depending on their responses to a 3-item questionnaire (individualized preparation, group C). Results. 185 patients were randomized during the study period and 143 patients were included in the final analysis. Patients in the individualized group had a median BBPS of 7 compared to a median of 6 in the standard group (p = 0.7). Also, there was no significant difference in patients’ comfort scores, irrespective of study group or laxative regimen. However, on multivariable analysis, a split-dose 4L polyethylene-glycol was an independent predictor for achieving a BBPS>6 (OR 3.7, 95% CI 1.4-9.8), regardless of patient-related factors. Conclusion. The choice of laxative seems to be more important than patient-related factors in predicting bowel cleansing. Comfort during bowel prep is not influenced by the type of strategy used.

Download Full-text

Comparing Impacts of Different Bowel Cleansing Agents and Oral Probiotics After Cleansing On Symptom and Microbiota: a Randomized Placebo-Controlled Trial

10.21203/rs.3.rs-1228536/v1 ◽

2022 ◽

Author(s):

Penghui Dai ◽

Feng Tang ◽

Ke Gan ◽

Qing Hu ◽

Jingyuan Liao ◽

...

Keyword(s):

Side Effects ◽

Bowel Preparation ◽

Controlled Trial ◽

Abdominal Symptoms ◽

Bowel Cleansing ◽

Long Term Follow Up ◽

Large Retrospective Study

Abstract Background: Sodium sulfate-based purge has shown better quality of bowel preparation than polyethylene glycol (PEG) in a large retrospective study. However, its side effects and impact to gut microbiota have not been assessed. Besides, evidence from intestinal microecology that probiotics were beneficial to individuals who received bowel preparation is still lacking. The aims are to evaluate the side effects and microecological impact of two bowel cleansing agents (PEG and mirabilite), as well as the regulating effect of probiotics on microecosystem perturbed by bowel preparation.Results: Mirabilite preparation appeared superior to PEG preparation in terms of side effects, consumed time and volume of solutions. Quantitative PCR results showed that the recovery rate of total microbial load in mirabilite group was faster than that in PEG group. 16S rRNA sequencing showed that there were no significant differences in effects of two bowel cleansing agents on multiple microbiota diversity metrics. And both laxatives may affect the relative abundance of core microbiota until 28 days after bowel preparation. Probiotics supplementation was beneficial to recovery of perturbed microecosystem and the maintenance of homeostasis in the gut according to our results. Moreover, probiotics supplementation relieved abdominal symptoms and few individual events induced by bowel preparation during long-term follow-up.Conclusions: Mirabilite could be an optimal bowel cleansing agent for healthy people and can be applied broadly. Besides, probiotics are suggested to administrate after bowel cleansing as it brings multiple benefits in our study.

Download Full-text

3 Liter Polyethylene Glycol is Not Inferior to The Standard Bowel Preparation in Chinese Population with Equal Efficacy: A Randomized, Controlled Trial

10.21203/rs.3.rs-770238/v1 ◽

2021 ◽

Author(s):

Peng Cheng ◽

Qing-qi Chen ◽

Ju-yuan Li ◽

Zheng Cheng ◽

Dian-hua Guo ◽

...

Keyword(s):

Polyethylene Glycol ◽

Adverse Events ◽

Bowel Preparation ◽

Chinese Population ◽

Controlled Trial ◽

Chinese Patients ◽

Procedure Time ◽

Adenoma Detection ◽

Bowel Cleansing

Abstract Background Ideal bowel cleansing regimens should be both effective and well tolerated. The European Society of Gastrointestinal Endoscopy recommends 4L Polyethylene Glycol (PEG) as the standard regimen for the bowel preparation (BP). This large volume of PEG ensures a better-quality bowel cleansing but might be poorly tolerated amongst the Chinese population given their different characteristics. The current study compared the 3L and 4L PEG with regard to their effectiveness, tolerability, and safety amongst Chinese patients to identify the better suitable bowel cleansing method for this population. Methods This study employed a prospective, observer-blinded, randomized and controlled design in a high-volume endoscopic center. Consecutive patients undergoing colonoscopy were randomly assigned (1:1) to the 3L-PEG or 4L-PEG group. The quality of bowel cleansing, procedure time, adenoma detection rate (ADR), patient tolerance, and adverse events were compared. Results A total of 330 patients were included in the study. The quality of the bowel cleansing (Boston Bowel Preparation Scale) for both the whole intestine and each segment showing no significant differences between the groups. No significant differences were present with regard to the procedure time or ADR. The incidences of adverse events such as nausea (P = 0.001) and bloating (P < 0.001)were significantly lower in the 3L-PEG group. Moreover, there was a significantly higher rate of satisfaction in 3L-PEG group than that of the 4L-PEG group (P = 0.009). Conclusions 3L-PEG bowel cleansing represents an optimal alternative to a 4L-PEG preparation for Chinese people, showing a similar efficacy and superior levels of satisfaction, acceptability, and safety amongst users. We recommend 3L PEG be the routine regimen in the clinical setting for Chinese patients. (ClinicalTrials.gov registration number: NCT03356015, registered in 29 November, 2017, https://www.clinicaltrials.gov/ct2/show/NCT03356015)

Download Full-text

Prospective randomized controlled trial comparing efficacy of 1-L Peg-Asc with prucalopride and 2-L Peg-Asc for the bowel preparation.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.597 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 597-597

Author(s):

Seong Ji Choi ◽

Yoon Tae Jeen ◽

Eun Sun Kim ◽

Woojung Kim ◽

Geeho Min ◽

...

Keyword(s):

Bowel Preparation ◽

Controlled Trial ◽

Split Dose ◽

Colon Cleansing ◽

Bowel Cleansing ◽

Prospective Randomized Controlled Trial ◽

Group A ◽

Survey Results ◽

Group B

597 Background: Though numerous researches enabled decrease of the bowel preparation solution volume, it is still a major complaint of patients preparing colonoscopy. There have been studied that additional administration of laxatives could lessen the amount of aqueous formula with prokinetic effect. Prucalopride is a serotonin (5-HT4) receptor agonist which stimulate colonic mass movements and provide main propulsive force for defecation. The aim of this study is to compare 2-L PEG-Asc and 1-L PEG-Asc plus prucalopride for quality of bowel cleansing while preparing for colonoscopy and patient compliance. Methods: Two hundred patients were prospectively enrolled. Patients referred for colonoscopy were divided into group A (the split-dose 2-L PEG-Asc) and group B (1-L PEG-Asc + prucalopride) randomly. During colonoscopy, each patient’s bowel preparation quality was evaluated with The Boston Bowel Preparation Scale (BBPS) and Aronchick Preparation Scale (APS). The tolerability and satisfaction of patients was determined based on a questionnaire-based survey. Results: One hundred patients received either 2-L PEG-Asc or 1-L PEG-Asc with prucalopride. Regarding colon cleansing outcome (BPPS and APS), the 1-L PEG-Asc with prucalopride group showed similar, but non-inferior results compared to the 2-L PEG-Asc group on both BBPS (7.65±1.27 vs 7.52±1.40, p = 0.586) and APS scales (93.3% vs 95%, p = 0.717). Tolerability was similar for both 1-L PEG-Asc with prucalopride and 2-L PEG-Asc. Conclusions: 1-L PEG-Asc plus prucalopride preparation showed comparable result to traditional 2-L PEG-Asc preparation. 1-L PEG-Asc plus prucalopride preparation method could be an alternative method for bowel preparation which can relieve patient’s discomfort. Clinical trial information: KCT0002409.

Download Full-text