Comparison of Gastric Residual Volume and pH between Single and Split-Dose Bowel Preparation in Patients Undergoing Esophago-Gastro-Duodenoscopy and Colonoscopy: A Randomized Controlled Trial

Background: Colonoscopy is an effective surveillance for the diagnosis and screening of colorectal cancer (CRC). Prior to the procedure, people would take laxatives for a good visualization of bowel texture. Although a split-dose bowel preparation has become popular, many anesthesiologists are concerned about pulmonary aspiration. Objective: To study the gastric residual volume and pH in patients taking split-dose bowel preparation as compared to those having laxatives on the day before the procedure. Materials and Methods: One hundred patients were randomized equally into two groups, as A for a single-dose, and B for a split-dose regimen. All patients underwent endoscopy under standard anesthetic care. The total gastric residual volume was suctioned, and pH was measured through the endoscope. The surgical team was unaware of the study protocol. The quality of bowel cleansing was assessed by the endoscopist using the Boston Bowel Preparation Scale (BBPS). Results: The bowel cleansing, the latency period, the endoscopist and patients’ satisfaction of single-and split-dose group were 7.06±1.4 and 8.14±1.1, 13.3±1.1 and 4.2±0.4 hours, 62.0% and 94.0%, and 90.0% and 74.0%, respectively. They all showed statistically significant differences between the two groups (p<0.05). Conclusion: The gastric residual volume and pH were not different between the split and single-dose preparations. Therefore, it might not increase the risk of aspiration pneumonitis. However, the split-dose technique was more effective in colon cleansing, patients’ tolerability, acceptability, and compliance than the preparations administered entirely the day or evening before the surgical procedure. Keywords: Gastro-colonoscopy; Single-dose bowel preparation; Split-dose bowel preparation; Gastric residual volume; Anesthesia

The Prediction of Inadequate Colon Capsule Cleansing: A Cohort Selection Guided by CC-CLEAR

<b><i>Introduction:</i></b> In order to optimize the rate of adequate cleansing in colon capsule, it may be important to identify risk factors that can predict a suboptimal colon preparation. <b><i>Aim:</i></b>To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report). <b><i>Methods:</i></b> Retrospective, single center, cohort study. Patients’ demographics, data, and quality of bowel preparation, according to CC-CLEAR, were collected retrospectively. A univariate analysis tested the association between covariables and the outcome, inadequate cleansing. The statistically significant variables were included in multivariable logistic binary regression, and a receiver operating characteristic curve (ROC) assessment was performed. <b><i>Results:</i></b> We included 167 consecutive colon capsules. Sixty-eight percent (<i>n</i> = 114) of patients were female, with a mean age of 64 years. The main indication for colon capsule was previous incomplete colonoscopy, in 158 patients (94.6%). The colon capsules cleansing was graded as good or excellent in 96 patients (57.5%) and as inadequate in 71 (42.5%), according to CC-CLEAR. The variables inadequate previous colon cleansing (OR adjusted 41.72 [95% CI 12.57–138.57], <i>p</i> value &#x3c; 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], <i>p</i> value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], <i>p</i> value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], <i>p</i> value = 0.031) were independently associated with the outcome inadequate cleansing, after adjusting for confoundment. The model presented an excellent discriminative power towards the outcome variable (AUC ROC 0.937 [CI 95% 0.899–0.975], <i>p</i> value &#x3c; 0.001). <b><i>Conclusion:</i></b> A previous inadequate colon cleansing, the use of chronic laxative and antidepressant, or impaired mobility are predictors of inadequate colon capsule cleansing, as assessed by the CC-CLEAR. These 4 predictors come together as a model enabling an accurate categorization of the patients at major risk of inadequate bowel preparation for capsule colonoscopy, with an excellent discriminative power and performance, which seems useful for the selection of patients for tailored optimization of the colon cleansing protocol.

Bowel preparation with 1L polyethylene glycol and ascorbate NER1006 doubles the chance to detect three or more adenomas in overweight or obese males

Background and study aims Men have more colon cleansing failures, colorectal adenomas, and colorectal cancers than women. We analyzed whether 1-liter (1 L) polyethylene glycol (PEG) NER1006 improves high-quality (HQ) colon cleansing and adenoma detection in males versus two mid-volume alternatives. Patients and methods The analysis of 1028 adult patients in two randomized clinical trials was performed. Adenoma detection and HQ cleansing were compared for overnight split dosing regimens with NER1006 (n = 513) versus combined oral sulfate solution or 2 L PEG + ascorbate (OSS/2 L PEG) (n = 515). Analyses included males versus females, overweight or obese (OO) males versus lean males, and NER1006 versus OSS/2 L PEG. In male patients, the adenoma detection rate of at least 3 (ADR3 +) was predicted with multiple logistic regression and statistical comparisons used the two-sided t-test. Results ADR3 + was greater in males versus females (10.7 % [56/524] versus 5.8 % [29/504]; P = 0.004) despite comparable adequate cleansing success rates (93.2 % [479/514] versus 93.0 % [466/501]; P = 0.912) and more HQ-scores in females (41.6 % [1069/2570] versus 45.3 % [1134/2505]; P = 0.008). ADR was almost twice as high in OO versus lean males (43.4 % [184/424] versus 23.1 % [21/91]; P < 0.001). Multivariate logistic regression predicted ADR3 + detection to be twice as likely in OO males using NER1006 versus OSS/2 L PEG (odds ratio (95 % confidence interval [CI]) = 2.049 (1.082–3.973); P = 0.030) and 90 % more likely in all males (1.902 (1.045–3.526); P = 0.037). In males, including OO males, NER1006 attained more HQ-scores per trial than OSS or 2 L PEG (P ≤ 0.017 for all comparisons). Conclusions NER1006 predicted the detection of more males for frequent surveillance than OSS/2 L PEG.

Colitis Induced by Colon-Cleansing Agent

Constipation is one of the most common functional gastrointestinal disorders and affects 20% of the general population. Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract that affects the large intestine and is characterized by chronic abdominal pain and altered bowel habits. We report a case of a 35-year-old African American man with a past medical history of IBS who presented to the clinic with a chief complaint of abdominal pain and bloody diarrhea for 1 week. The patient stated that he used a colon-cleansing agent because of persistent constipation. Computed tomography scan of the patient’s abdomen and pelvis with contrast was performed which showed diffuse contiguous segmental mural thickening and nodularity seen along the distal transverse, descending, and sigmoid colon. Colonoscopy showed moderate diffuse inflammation characterized by altered vascularity, erythema, and granularity from the rectum to the descending colon, and localized mild inflammation characterized by erythema was found at the ileocecal valve. The patient’s clinical condition improved with symptomatic management over 10 days. Patients with IBS should be advised to restrain from using a colon-cleansing agent without advice from their primary doctor as it can lead to various complications.

Modern and promising ways of bowel preparation for instrumental research

A review is presented to summarize data on intestinal preparation approaches and methods for research. The historical background and main stages in the development of the intestinal lavage method are highlighted, and traditional and modern methods of evaluating its effectiveness are characterized. Dietary recommendations and information about the basic drugs used nowadays in preparation of the intestine for instrumental research are adduced. Clinical aspects of different types of osmotic action of drugs are considered. The composition of laxatives for salt and electrolyte components in terms of potential benefit and risk in patients is analyzed. The main positions of the current recommendations of domestic, European and American expert communities concerning the discussed topic are taken into account. Demonstrated “no less efficacy” of sulfate solution compared with macrogol in adult patients. Clinical case is presented: patient A., 22 years old, admitted to the clinic with complaints of recurrent pain in the left abdomen, frequent stools, sometimes with blood, loss of hair, flaky spots on the skin of the upper extremities. The patient was prepared for the examination – colon cleansing with a sulfate drug, endoscopic examination of the colon - colonoscopy was performed. Diagnosis: nonspecific ulcerative colitis. The treatment scheme is presented, clinical remission of the disease is achieved.