scholarly journals Safety of Polyethylene Glycol Solution plus Ascorbic Acid for Bowel Preparation for Colonoscopy in Patients with Chronic Kidney Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Naoki Ohmiya ◽  
Yoshihito Nakagawa ◽  
Noriyuki Horiguchi ◽  
Takafumi Omori ◽  
Toshiaki Kamano ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ascorbic Acid ◽  
Polyethylene Glycol ◽  
Kidney Disease ◽  
Adverse Events ◽  
Bowel Preparation ◽  
Vital Signs ◽  
Before And After ◽  
Blood And Urine Samples ◽  
Glycol Solution

Introduction. Polyethylene glycol-electrolyte lavage solution plus ascorbic acid (PEG-ELS-Asc) has been recommended for colonoscopy, but little is known about the safety of PEG-ELS-Asc in patients with chronic kidney disease (CKD). The aim of this study was to determine its safety and efficacy in CKD patients. Methods. Blood and urine samples prospectively collected before and after same-day bowel preparation for colonoscopy with the conventional volume of PEG-ELS-Asc, vital signs before and after colonoscopy, and adverse events within 30 days postcolonoscopy were analyzed in consenting patients with CKD. The cleansing level was evaluated with the Boston bowel preparation score (BBPS) from colonoscopic findings. Results. Of 57 patients enrolled, 1 was excluded for refusal. Serum bicarbonate significantly dropped, and blood hemoglobin, serum total protein, albumin, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, total bilirubin, and uric acid significantly rose after bowel preparation, although these changes were not clinically important. Only in nondialysis patients did the platelet count and potassium significantly rise, although these changes were not clinically important either. Renal function, such as the urea, creatinine, and estimated glomerular filtration rate, was not significantly altered. An adequate bowel cleansing score, BBPS ≥ 6 , was achieved in 94% of patients. The blood pressure and heart rate were not significantly different between before and after colonoscopy in either nondialysis ( n = 32 ) or dialysis ( n = 19 ) patients. There were no adverse events associated with bowel preparation and colonoscopy within 30 days postcolonoscopy. Conclusions. The conventional volume of same-day bowel preparation with PEG-ELS-Asc may be safe and effective in CKD patients.

scholarly journals Polyethylene glycol plus ascorbic acid for bowel preparation in chronic kidney disease

Medicine ◽  
2016 ◽  
Vol 95 (36) ◽  
pp. e4755 ◽  
Author(s):  
Jae Min Lee ◽  
Bora Keum ◽  
In Kyung Yoo ◽  
Seung Han Kim ◽  
Hyuk Soon Choi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ascorbic Acid ◽  
Polyethylene Glycol ◽  
Kidney Disease ◽  
Bowel Preparation

scholarly journals Bowel preparation for performing a colonoscopy: prospective randomized comparison study between a low-volume solution of polyethylene glycol and bisacodyl versus bisacodyl and a mannitol solution

2012 ◽  
Vol 49 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Manoel Carlos Vieira ◽  
Claudio Lyoiti Hashimoto ◽  
Flair José Carrilho
Keyword(s):  
Polyethylene Glycol ◽  
Vital Signs ◽  
Abdominal Distension ◽  
Similar Efficacy ◽  
Preparation Methods ◽  
Gold Standard Method ◽  
Mannitol Solution ◽  
Before And After ◽  
Glycol Solution

CONTEXT: Colonoscopy is currently the gold standard method to examine the colon, the rectum and the terminal ileum. In order to perform the colonoscopy, it is necessary to clean the bowel and use medications that are generally poorly tolerated by the patients. OBJECTIVE: Compare the tolerability, acceptability, safety and efficacy of two solutions used for intestinal preparation for a colonoscopy. METHODS: One hundred patients matched for sex and age were prospective randomized into two groups. Polyethylene glycol group received bisacodyl 10 mg plus 1 L of polyethylene glycol the night before and 1 L on the day of the exam. Mannitol group received bisacodyl 20 mg the day before and 1 L of a 10% mannitol solution on the day of the exam. The diet was the same for both groups. Tolerability and acceptability were measured using previously validated questionnaires. In terms of safety, variations in vital signs before and after the preparation were recorded, in addition to any complications. The quality of the preparation was graded based on the Boston and Ottawa scales. RESULTS: Ninety-six percent (96%) completed the study. As for tolerability, the mannitol preparation group exhibited a significantly higher frequency of nausea, vomiting, abdominal pain, and abdominal distension than polyethylene glycol group (P < 0.05). Acceptability was significantly better in polyethylene glycol group. The polyethylene glycol solution has also previously been shown to be safer than mannitol. No difference was observed in the quality of the preparation between the two preparation methods. CONCLUSIONS: The following conclusions can be made: polyethylene glycol solution had higher tolerability, acceptability, and safety than the mannitol and should be used instead of mannitol. Both preparation solutions have similar efficacy.

scholarly journals Bowel Preparation for Colonoscopy with Sodium Phosphate Solution versus Polyethylene Glycol-Based Lavage: A Multicenter Trial

2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
Author(s):  
S. Schanz ◽  
W. Kruis ◽  
O. Mickisch ◽  
B. Küppers ◽  
P. Berg ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Adverse Events ◽  
Bowel Preparation ◽  
Sodium Phosphate ◽  
Vital Signs ◽  
Multicenter Trial ◽  
Phosphate Solution ◽  
Blinded Study ◽  
Sodium Phosphate Solution ◽  
Oral Sodium Phosphate

Background: Adequate bowel preparation is essential for accurate colonoscopy. Both oral sodium phosphate (NaP) and polyethylene glycol-based lavage (PEG-ELS) are used predominantly as bowel cleansing modalities. NaP has gained popularity due to low drinking volume and lower costs. The purpose of this randomized multicenter observer blinded study was to compare three groups of cleansing (NaP, NaP + sennosides, PEG-ELS + sennosides) in reference to tolerability, acceptance, and cleanliness. Patient and Methods: 355 outpatients between 18 and 75 years were randomized into three groups (A, B, C) receiving NaP = A, NaP, and sennosides = B or PEG-ELS and sennosides = C. Gastroenterologists performing colonoscopies were blinded to the type of preparation. All patients documented tolerance and adverse events. Vital signs, premedication, completeness, discomfort, and complications were recorded. A quality score (0–4) of cleanliness was generated. Results: The three groups were similar with regard to age, sex, BMI, indication for colonoscopy, and comorbidity. Drinking volumes (L) (A = 4.33 + 1.2, B = 4.56 + 1.18, C = 4.93 + 1.71) were in favor of NaP (P = .005). Discomfort from ingested fluid was recorded in A = 39.8% (versus C: P = .015), B = 46.6% (versus C: P = .147), and C = 54.6%. Differences in tolerability and acceptance between the three groups were statistically not significant. No differences in adverse events and the cleanliness effects occurred in the three groups (P = .113). The cleanliness quality scores 0–2 were calculated in A: 77.7%, B: 86.7%, and C: 85.2%. Conclusions: These data fail to demonstrate significant differences in tolerability, acceptance, and preparation quality between the three types of bowel preparation for colonoscopy. Cleansing with NaP was not superior to PEG-ELS.

Effect of Coffee Added to a Polyethylene glycol plus Ascorbic acid Solution for Bowel Preparation prior to Colonoscopy

2016 ◽  
Vol 25 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Sung Won Jung ◽  
In Ho Moh ◽  
Hana Yoo ◽  
Sung Ill Jang ◽  
Su Rin Shin ◽  
...  
Keyword(s):  
Ascorbic Acid ◽  
Polyethylene Glycol ◽  
Adverse Events ◽  
Acid Solution ◽  
Bowel Preparation ◽  
Patient Comfort ◽  
Clinical Indication ◽  
Polyp Detection ◽  
Ascorbic Acid Solution ◽  
Polyp Detection Rate

Background & Aims: Conventional bowel cleansers for colonoscopy have an unpleasant taste and a large volume of solution must be ingested. Coffee increases bowel motility and has an intense flavor. The addition of coffee to a polyethylene glycol+ascorbic acid solution reduces the volume of the solution to be consumed without reducing efficacy, improves the taste of the solution and enhances patient comfort. Methods: Outpatients with clinical indication or people who wanted screening for cancer were considered eligible. Control group (PEGAS group) consumed a 1-L solution of polyethylene glycol+ascorbic acid twice. Study group (COF group) consumed 750 mL of coffee+polyethylene glycol+ascorbic acid twice. Bowel cleansing was rated using the Aronchick, Ottawa scale, polyp detection rate and colonoscopic insertion time. Tolerability, acceptability, preference, and adverse events were investigated by questionnaires. Results: The COF group had non-inferiority in efficacy (non-inferiority margin, -15 %; lower limit of 95 % confidence interval for difference between success rates, – 4.7 % and –8.4 % from both scales, respectively). Polyp detection rates were 0.48 and 0.60, respectively (P=0.067). Colonoscopic insertion times were 323.6±166.8 s and 330.7±243.6 s, respectively (P=0.831). Significant improvement was observed with respect to ease of drinking (P=0.012), taste (P=0.026) and preference (P=0.046) in the COF group. Adverse events occurred in 52.4 % and 60.4 % in the two groups, respectively (P = 0.251). Conclusion: The addition of coffee to polyethylene glycol+ascorbic acid solution reduces the required volume for bowel preparation without reduced efficacy and enhances patient comfort in coffee-drinkers. Abbreviations: ASC: ascorbic acid; PEG: polyethylene glycol; AE: adverse event; PP: per protocol; ITT: intention-to-treat; PICO: sodium picosulfate.

scholarly journals Severe symptomatic hyponatremia associated with the use of polyethylene glycol-based bowel preparation

2017 ◽  
Vol 2017 ◽  
Author(s):  
Navira Samad ◽  
Ian Fraser
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Polyethylene Glycol ◽  
Kidney Disease ◽  
Bowel Preparation ◽  
Thiazide Diuretics ◽  
Osmotic Demyelination Syndrome ◽  
Osmotic Demyelination ◽  
Bowel Cleansing ◽  
History Of

Summary Colonoscopy is a useful tool in modern medicine and is increasingly employed for both diagnostic and treatment reasons. However, its effectiveness is highly reliant on the quality of bowel cleansing. Among different bowel-cleansing agents available, PEG (polyethylene glycol) is considered to be the safest cleansing agent, especially in relation to fluid and electrolyte problems. We present here a case of severe symptomatic hyponatremia that developed after the use of PEG for an elective colonoscopy. This case highlights that despite the use of PEG-based preparations, life-threatening fluid and electrolyte disturbances can still occur in patients with risk factors, such as old age, use of thiazide diuretics and SSRIs, chronic kidney disease, heart failure and a history of electrolyte problems. These patients should be closely monitored when undertaking bowel cleansing and should receive prompt care in the event of complications, to avoid permanent neurological sequelae and death. Rapid correction of sodium levels in patients requiring treatment of hyponatremia should be avoided to prevent complications such as osmotic demyelination syndrome. Learning points: PEG is considered to be the safest bowel-cleansing agents among different options available, but it can still cause significant side effects in susceptible individuals. Those at risk of developing adverse events include elderly individuals, patients with chronic kidney disease, heart failure or previous history of electrolyte problems and those taking thiazide diuretics and SSRIs. All such patients should be closely monitored i.e. have their metabolic profile checked prior to the commencement of bowel cleansing and a low threshold should be kept for the initiation of investigations and treatment in case of development of symptoms. Medications with a potential of causing fluid and electrolytes such as thiazide diuretics and SSRIs should be withheld while patient is undertaking bowel preparation. Hyponatremia in a hospitalized patient can be multifactorial, and the treatment principles are based on duration of onset, presence of symptoms and patients volume status. Overzealous correction of sodium levels during treatment of hyponatremia can result in serious complications such as osmotic demyelination syndrome.

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