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Wang F, Huang X, Wang Z, Yan Z, Wang S, Pan P, Li Z, Bai Y. One-day versus three-day low-residue diet bowel preparation regimens before colonoscopy: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2024; 39:787-795. [PMID: 38251810 DOI: 10.1111/jgh.16466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND AIM Although studies have shown that the quality of bowel preparation with low-residue diet (LRD) is as effective as that of clear fluid diet (CLD), there is currently no consensus on how long an LRD should last. The aim of this study was to compare a 1-day versus 3-day LRD on bowel preparation before colonoscopy. METHODS A systematic review search was conducted in MEDLINE/PubMed, EMBASE, Web of Science, and Cochrane database from inception to April 2023. We identified randomized controlled trials (RCTs) that compared 1-day with 3-day LRD bowel cleansing regiments for patients undergoing colonoscopy. The rate of adequate bowel preparation, polyp detection rate, adenoma detection rate, tolerability, willingness to repeat preparation, and adverse events were estimated using odds ratios (OR) and 95% confidence interval (CI). We also performed meta-analysis to identify risk factors and predictors of inadequate preparation. RESULTS Four studies published between 2019 and 2023 with 1927 participants were included. The present meta-analysis suggested that 1-day LRD was comparable with 3-day LRD for adequate bowel preparation (OR 0.89; 95% CI, 0.65-1.21; P = 0.45; I2 = 0%; P = 0.52). The polyp detection rate (OR 0.94; 95% CI, 0.77-1.14; P = 0.52; I2 = 23%; P = 0.27) and adenoma detection rate (OR 0.87; 95% CI, 0.71-1.08; P = 0.21; I2 = 0%; P = 0.52) were similar between the groups. There were significantly higher odds of tolerability in patients consuming 1-day LRD compared with 3-day LRD (OR 1.64; 95% CI, 1.13-2.39; P < 0.01; I2 = 47%; P = 0.15). In addition, constipation was identified as the independent predictor of inadequate preparation (OR 1.98; 95% CI, 1.27-3.11; P < 0.01; I2 = 0%; P = 0.46). CONCLUSION The present study demonstrated that a 1-day LRD was as effective as a 3-day CLD in the quality of bowel preparation before colonoscopy and significantly improved tolerability of patients. In addition, constipation is an independent risk factor of poor bowel preparation, and the duration of LRD in patients with constipation still needs further clinical trials.
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Affiliation(s)
- Fan Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xinxin Huang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhijie Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ziwei Yan
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shuling Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Peng Pan
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
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Machlab S, Martínez-Bauer E, López P, Ruiz-Ramirez P, Gómez B, Gimeno-Garcia AZ, Pujals MDM, Tanco S, Sargatal L, Pérez B, Justicia R, Enguita M, Piqué N, Valero O, Calvet X, Campo R. Restrictive diets are unnecessary for colonoscopy: Non-inferiority randomized trial. Endosc Int Open 2024; 12:E352-E360. [PMID: 38464979 PMCID: PMC10919995 DOI: 10.1055/a-2256-5356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/06/2024] [Indexed: 03/12/2024] Open
Abstract
Background and study aims In colonoscopy, preparation is often regarded as the most burdensome part of the intervention. Traditionally, specific diets have been recommended, but the evidence to support this policy is insufficient. The aim of this study was to evaluate the impact of the decision not to follow a restrictive diet on bowel preparation and colonoscopy outcomes. Patients and methods This was a multicenter, controlled, non-inferiority randomized trial with FIT-positive screening colonoscopy. The subjects were assigned to follow the current standard (1-day low residue diet [LRD]) or a liberal diet. The allocation was balanced for the risk of inadequate cleansing using the Dik et al. score. All participants received the same instructions for morning colonoscopy preparation. The primary outcome was the rate of adequate preparations as defined by the Boston Bowel Preparation Scale. Secondary outcomes included tolerability and measures of colonoscopy performance and quality. Results A total of 582 subjects were randomized. Of these, 278 who received the liberal diet and 275 who received the 1-day LRD were included in the intent-to-treat analysis. Non-inferiority was demonstrated with adequate preparation rates of 97.8% in the 1-day LRD and 96.4% in the liberal diet group. Tolerability was higher with the liberal diet (94.7% vs. 83.2%). No differences were found with respect to cecal intubation time, aspirated volume, or length of the examination. Global and right colon average adenoma detection rates per colonoscopy were similar. Conclusions The liberal diet was non-inferior to the 1-day LRD, and increased tolerability. Colonoscopy performance and quality were not affected. (NCT05032794).
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Affiliation(s)
- Salvador Machlab
- Digestive Endoscopy Unit, Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Eva Martínez-Bauer
- Digestive Endoscopy Unit, Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Pablo Ruiz-Ramirez
- Gastroenterology Department, Hospital Universitari Mùtua de Terrassa, Terrassa, Spain
| | - Bárbara Gómez
- Gastroenterology Department, Hospital de Mataró, Mataró, Spain
| | | | - María del Mar Pujals
- Gastroenterology Department, Hospital Universitari Mùtua de Terrassa, Terrassa, Spain
| | - Sara Tanco
- Gastroenterology Department, Hospital de Mataró, Mataró, Spain
| | - Lluïsa Sargatal
- Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Betty Pérez
- Gastroenterología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Reyes Justicia
- Colorectal Cancer Screening Office, Consorci Sanitari de Terrassa, Terrassa, Spain
| | | | - Nùria Piqué
- Institut de Recerca en Nutrició i Seguretat Alimentària de la UB (INSA-UB), Universitat de Barcelona Facultat de Farmàcia i Ciències de l'Alimentació, Barcelona, Spain
| | - Oliver Valero
- Mathematics Department and Applied Statistics, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Xavier Calvet
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Gastroenterology Department, Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Rafel Campo
- Digestive Endoscopy Unit, Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Parodi MC, Antonelli G, Galloro G, Radaelli F, Manes G, Manno M, Camellini L, Sereni G, Caserta L, Arrigoni A, Fasoli R, Sassatelli R, Pigò F, Iovino P, Scimeca D, De Luca L, Rizkala T, Tringali A, Campari C, Capogreco A, Testoni SGG, Bertani H, Fantin A, Mitri RD, Familiari P, Labardi M, De Angelis C, Anghinoni E, Rubeca T, Cassoni P, Zorzi M, Mussetto A, Hassan C, Senore C. SIED-GISCOR recommendations for colonoscopy in screening programs: Part I - Diagnostic. Dig Liver Dis 2023:S1590-8658(23)01070-8. [PMID: 38105148 DOI: 10.1016/j.dld.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
The implementation of FIT programs reduces incidence and mortality from CRC in the screened subjects. The ultimate efficacy for CRC morbidity and mortality prevention in a FIT program depends on the colonoscopy in FIT+ subjects that has the task of detecting and removing these advanced lesions. Recently, there has been growing evidence on factors that influence the quality of colonoscopy specifically withing organized FIT programs, prompting to dedicated interventions in order to maximize the benefit/harm ratio of post-FIT colonoscopy. This document focuses on the diagnostic phase of colonoscopy, providing indications on how to standardise colonoscopy in FIT+ subjects, regarding timing of examination, management of antithrombotic therapy, bowel preparation, competence and sedation.
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Affiliation(s)
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Giuseppe Galloro
- Surgical Endoscopy Unit, Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy
| | | | - Giampiero Manes
- Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, (Modena), Modena, Carpi, Italy
| | | | - Giuliana Sereni
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Caserta
- Department of Medicine - Unit of Gastroenterology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Arrigo Arrigoni
- Diagnostic and Interventional Digestive Endoscopy, FPO-IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Renato Fasoli
- Department of Gastroenterology and Digestive Endoscopy, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Romano Sassatelli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, SA, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy
| | - Luca De Luca
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Tommy Rizkala
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | | | - Cinzia Campari
- Screening Unit, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Capogreco
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Sabrina Gloria Giulia Testoni
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, (Modena), Modena, Carpi, Italy
| | - Alberto Fantin
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy
| | - Pietro Familiari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Maurizio Labardi
- Gastroenterology and Endoscopy Department, Firenze Hospital, Firenze, Italy
| | - Claudio De Angelis
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Emanuela Anghinoni
- Servizio Medicina Preventiva nelle Comunità - AUSL Mantova, via Dei Toscani 1, 46100 Mantova, Italy
| | - Tiziana Rubeca
- S.C. Laboratorio regionale prevenzione oncologica, ISPO, Firenze, Italy
| | - Paola Cassoni
- Department of Medical Science, Pathology unit, University of Turin, Turin, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Alessandro Mussetto
- Gastroenterology Unit, Azienda Unità Sanitaria Locale della Romagna, Santa Maria delle Croci Hospital, Viale Vincenzo Randi, 5, Ravenna 48121, Italy
| | - Cesare Hassan
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.
| | - Carlo Senore
- SSD Epidemiologia e screening - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
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Hsu WF, Chiu HM. Optimization of colonoscopy quality: Comprehensive review of the literature and future perspectives. Dig Endosc 2023; 35:822-834. [PMID: 37381701 DOI: 10.1111/den.14627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/27/2023] [Indexed: 06/30/2023]
Abstract
Colonoscopy is crucial in preventing colorectal cancer (CRC) and reducing associated mortality. This comprehensive review examines the importance of high-quality colonoscopy and associated quality indicators, including bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate (ADR), complete resection, specimen retrieval, complication rates, and patient satisfaction, while also discussing other ADR-related metrics. Additionally, the review draws attention to often overlooked quality aspects, such as nonpolypoid lesion detection, as well as insertion and withdrawal skills. Moreover, it explores the potential of artificial intelligence in enhancing colonoscopy quality and highlights specific considerations for organized screening programs. The review also emphasizes the implications of organized screening programs and the need for continuous quality improvement. A high-quality colonoscopy is crucial for preventing postcolonoscopy CRC- and CRC-related deaths. Health-care professionals must develop a thorough understanding of colonoscopy quality components, including technical quality, patient safety, and patient experience. By prioritizing ongoing evaluation and refinement of these quality indicators, health-care providers can contribute to improved patient outcomes and develop more effective CRC screening programs.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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5
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Gimeno-García AZ, Benítez-Zafra F, Nicolás-Pérez D, Hernández-Guerra M. Colon Bowel Preparation in the Era of Artificial Intelligence: Is There Potential for Enhancing Colon Bowel Cleansing? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1834. [PMID: 37893552 PMCID: PMC10608636 DOI: 10.3390/medicina59101834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Proper bowel preparation is of paramount importance for enhancing adenoma detection rates and reducing postcolonoscopic colorectal cancer risk. Despite recommendations from gastroenterology societies regarding the optimal rates of successful bowel preparation, these guidelines are frequently unmet. Various approaches have been employed to enhance the rates of successful bowel preparation, yet the quality of cleansing remains suboptimal. Intensive bowel preparation techniques, supplementary administration of bowel solutions, and educational interventions aimed at improving patient adherence to instructions have been commonly utilized, particularly among patients at a high risk of inadequate bowel preparation. Expedited strategies conducted on the same day as the procedure have also been endorsed by scientific organizations. More recently, the utilization of artificial intelligence (AI) has emerged for the preprocedural detection of inadequate bowel preparation, holding the potential to guide the preparation process immediately preceding colonoscopy. This manuscript comprehensively reviews the current strategies employed to optimize bowel cleansing, with a specific focus on patients with elevated risks for inadequate bowel preparation. Additionally, the prospective role of AI in this context is thoroughly examined. CONCLUSIONS While a majority of outpatients may achieve cleanliness with standard cleansing protocols, dealing with hard-to-prepare patients remains a challenge. Rescue strategies based on AI are promising, but such evidence remains limited. To ensure proper bowel cleansing, a combination of strategies should be performed.
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Samnani S, Khan R, Heitman SJ, Hilsden RJ, Byrne MF, Grover SC, Forbes N. Optimizing adenoma detection in screening-related colonoscopy. Expert Rev Gastroenterol Hepatol 2023:1-14. [PMID: 37158052 DOI: 10.1080/17474124.2023.2212159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Screening-related colonoscopy is a vital component of screening initiatives to both diagnose and prevent colorectal cancer (CRC), with prevention being reliant upon early and accurate detection of pre-malignant lesions. Several strategies, techniques, and interventions exist to optimize endoscopists' adenoma detection rates (ADR). AREAS COVERED This narrative review provides an overview of the importance of ADR and other colonoscopy quality indicators. It then summarizes the available evidence regarding the effectiveness of the following domains in terms of improving ADR: endoscopist factors, pre-procedural parameters, peri-procedural parameters, intra-procedural strategies and techniques, antispasmodics, distal attachment devices, enhanced colonoscopy technologies, enhanced optics, and artificial intelligence. These summaries are based on an electronic search of the databases Embase, Pubmed, and Cochrane performed on December 12, 2022. EXPERT OPINION Given the prevalence and associated morbidity and mortality of CRC, the quality of screening-related colonoscopy quality is appropriately prioritized by patients, endoscopists, units, and payers alike. Endoscopists performing colonoscopy should be up to date regarding available strategies, techniques, and interventions to optimize their performance.
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Affiliation(s)
- Sunil Samnani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Steven J Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert J Hilsden
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael F Byrne
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Bennett L, Knox R, Luscombe G, Egan J, Wallace L. The Colonoscopy Cookbook: Analysis of effect of a recipe resource on quality and experience of bowel preparation in colonoscopy. Endosc Int Open 2023; 11:E561-E565. [PMID: 37251792 PMCID: PMC10219782 DOI: 10.1055/a-2057-4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background High-quality bowel preparation for a colonoscopy improves identification of early lesions in the large bowel, decreases procedure time and increases intervals between colonoscopies. Current recommendations advise a low-residue diet in the days leading up to colonoscopy to improve quality of preparation. This study prepared and provided a recipe resource to patients undergoing colonoscopy and assessed the quality of bowel preparation and patient experience. Patients and methods A "Colonoscopy Cookbook" resource of recipes that comply with the preoperative diet recommendations was created and added to routine preoperative information given to patients undergoing elective colonoscopies at a regional Australian hospital over a 12-month period. Endoscopic reports were reviewed for each case and quality of bowel preparation was classified as "adequate'' or "inadequate". Data collected were compared to a representative local cohort from 2019. Results Procedure reports from 96 patients who were provided with the resource were compared with 96 patients who were not. Adequate bowel preparation was nine times as likely when the resource was available (odds ratio 8.54, 95 % confidence interval: 2.85 to 25.60, P < 0.001) compared to when it was not. The patient experience was assessed using a post-procedure survey, which demonstrated a positive experience in recipe preparation. Most patients would use the resource prior to future colonoscopies. Conclusions Further randomized controlled trials are required to validate this scoping review. Pre-procedure recipe resources may improve quality of bowel preparation in patients undergoing colonoscopy.
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Affiliation(s)
- Laura Bennett
- The Royal Melbourne Hospital City Campus, General Surgery, Victoria, Australia
- Orange Health Service, General Surgery, New South Wales, Australia
| | - Robert Knox
- Orange Health Service, General Surgery, New South Wales, Australia
| | - Georgina Luscombe
- The University of Sydney, School of Rural Health, Orange, New South Wales, Australia
| | - Jenny Egan
- Orange Health Service, Bowel Screen, Orange, South Wales, Australia
| | - Lauren Wallace
- The Royal Melbourne Hospital City Campus, General Surgery, Victoria, Australia
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Vemulapalli KC, Lahr RE, Rex DK. 2021 Patient Perceptions Regarding Colonoscopy Experience. J Clin Gastroenterol 2023; 57:400-403. [PMID: 35324481 DOI: 10.1097/mcg.0000000000001689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/07/2022] [Indexed: 12/10/2022]
Abstract
GOAL We sought to document patient perceptions in 2021 regarding colonoscopy experience and potential deterrents to repeat colonoscopy. BACKGROUND AND AIM Bowel preparation has been previously considered by patients to be the worst part of a colonoscopy. MATERIALS AND METHODS We conducted a prospective survey of consecutive patients age 18 years and older who had just completed colonoscopy at 2 outpatient endoscopy centers at a tertiary academic hospital. The short survey was conducted in the recovery area. The main outcome measure was patient perceptions of the worst part of their colonoscopy experience and which factor would most deter them from a future colonoscopy. RESULTS Four hundred patients completed the survey of 405 approached. Average patient age was 64 years, and 48% were women. Seventy-five percent of patients used low-volume preparations. Bowel preparation was considered the worst part of colonoscopy by 71% of patients. Women were more likely to choose laxatives as the worst part of a colonoscopy. Bowel preparation was chosen most often (55%) as the most likely deterrent to a future colonoscopy. There were minimal differences in responses between those receiving low-volume versus high-volume (4 L) preparations. CONCLUSION Bowel preparation remains the worst part of the colonoscopy experience for patients, and the most likely deterrent to future colonoscopy.
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Affiliation(s)
- Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, IN
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Pan P, Gu L, Zhao S, Wang S, Ma J, Fu H, Chen Y, He S, Tian Z, Xu L, Feng Z, Li Y, Yang Z, Yang L, Wang W, Hou Q, Liu T, Li C, Tian D, Wang X, Gao Y, Shi H, Bai Y, Li Z. Prepackaged formula low-residue diet vs. self-prepared low-residue diet before colonoscopy: A multicenter randomized controlled trial. Front Med (Lausanne) 2023; 10:1029493. [PMID: 37035340 PMCID: PMC10079983 DOI: 10.3389/fmed.2023.1029493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Background and aims Compared with self-prepared LRD, a prepackaged low-residue diet (LRD) can improve patient compliance, but whether it can further improve the quality of bowel preparation is uncertain. The study aimed to compare the application of the prepackaged formula LRD with self-prepared LRD in bowel preparation for colonoscopy. Methods A multicenter randomized controlled trial was conducted in 15 centers. The eligible subjects were randomly assigned to one of two groups: the formula LRD group and the self-prepared LRD group. On the day before the colonoscopy, subjects in the self-prepared LRD group were instructed to consume a restricted LRD prepared by themselves, while subjects in the formula LRD group were given six bags of prepackaged formula LRD and instructed to consume them according to their individual need. The primary outcome was an adequate bowel preparation rate. Secondary outcomes mainly included Boston Bowel Preparation Scale (BBPS) scores, dietary restriction compliance rate, tolerance, satisfaction, adenoma detection rate (ADR), and adverse reactions. The trial was registered at ClinicalTrials.gov under the identifier NCT03943758. Results A total of 550 subjects were recruited. Compared with the self-prepared LRD group, the formula LRD group showed a higher adequate bowel preparation rate (94.5 vs. 80.4%; P < 0.01), BBPS scores (7.87 ± 1.13 vs. 6.75 ± 1.47; P < 0.01), dietary compliance rate (92.4 vs. 78.9%; P < 0.01), tolerance (P < 0.01 in degree of hunger, intensity of physical strength, and negative influence on daily activities), satisfaction (8.56 ± 1.61 vs. 7.20 ± 2.02; P < 0.01), and ADR (25.6 vs. 16.0%; P < 0.01). There was no significant difference in adverse reactions. Conclusion Compared with self-prepared LRD, the formula LRD showed similar safety and higher bowel preparation quality, compliance, and tolerance in bowel preparation. More formula LRDs could be designed according to different dietary habits and ethnic populations, and further researches are warranted to confirm their effect. Clinical trial registration https://register.clinicaltrials.gov, identifier: NCT03943758.
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Affiliation(s)
- Peng Pan
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Naval Military Medical University, Shanghai, China
| | - Lun Gu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Naval Military Medical University, Shanghai, China
| | - Shengbing Zhao
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Naval Military Medical University, Shanghai, China
| | - Shuling Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Naval Military Medical University, Shanghai, China
| | - Jiayi Ma
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Naval Military Medical University, Shanghai, China
| | - Hongyu Fu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Naval Military Medical University, Shanghai, China
| | - Youxiang Chen
- Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Shuixiang He
- Department of Gastroenterology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zibin Tian
- Department of Gastroenterology, The Affiliated Hospital, Qingdao University, Qingdao, China
| | - Le Xu
- Department of Gastroenterology, Beijing Hospital, Beijing, China
| | - Zhijie Feng
- Department of Gastroenterology, The Second Hospital, Hebei Medical University, Shijiazhuang, China
| | - Yanqing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Zhuo Yang
- Digestive Endoscopy Center, Northern Theater General Hospital, Shenyang, China
| | - Lei Yang
- Digestive Endoscopy Center, Northern Theater General Hospital, Shenyang, China
| | - Wen Wang
- Department of Gastroenterology, The 900th Hospital of the Chinese People's Liberation Army (PLA), Fuzhou, China
| | - Qian Hou
- Department of Nutrition, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Chujun Li
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dean Tian
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xiaodi Wang
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Yongmei Gao
- Department of Gastroenterology, The First Affiliated Hospital, Hebei North University, Zhangjiakou, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Naval Military Medical University, Shanghai, China
- Yu Bai
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Naval Military Medical University, Shanghai, China
- *Correspondence: Zhaoshen Li
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10
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Chirila A, Nguyen ME, Tinmouth J, Halperin IJ. Preparing for Colonoscopy in People with Diabetes: A Review with Suggestions for Clinical Practice. J Can Assoc Gastroenterol 2022; 6:26-36. [PMID: 36789141 PMCID: PMC9915054 DOI: 10.1093/jcag/gwac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
People with diabetes have an increased risk of adverse events during the peri-colonoscopy period, including hypoglycemia, lactic acidosis, diabetic ketoacidosis and acute kidney injury. This is secondary to inadequate dietary modification, the bowel preparation and antihyperglycemic agent modification. With the availability of many new diabetes agents, endoscopists need updated guidance. This review of current literature provides a practical approach to antihyperglycemic agent modification in the context of colonoscopy preparation, as well as guidelines on dietary changes, the bowel preparation itself and glucose monitoring.
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Affiliation(s)
- Alexandra Chirila
- Correspondence: Alexandra Chirila, MSc, Department of Medicine, University of Toronto, Toronto, Ontario, Canada, e-mail:
| | - Mary E Nguyen
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill Tinmouth
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ilana J Halperin
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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11
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Gubbiotti A, Spadaccini M, Badalamenti M, Hassan C, Repici A. Key factors for improving adenoma detection rate. Expert Rev Gastroenterol Hepatol 2022; 16:819-833. [PMID: 36151898 DOI: 10.1080/17474124.2022.2128761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Colonoscopy is a fundamental tool in colorectal cancer (CRC) prevention. Nevertheless, one-fourth of colorectal neoplasms are still missed during colonoscopy, potentially being the main reason for post-colonoscopy colorectal cancer (PCCRC). Adenoma detection rate (ADR) is currently known as the best quality indicator correlating with PCCRC incidence. AREAS COVERED We performed a literature review in order to summarize evidences investigating key factors affecting ADR: endoscopists education and training, patient management, endoscopic techniques, improved navigation (exposition defect), and enhanced lesions recognition (vision defect) were considered. EXPERT OPINION 'Traditional' factors, such as split dose bowel preparation, adequate withdrawal time, and right colon second view, held a significant impact on ADR. Several devices and technologies have been developed to promote high-quality colonoscopy, however artificial intelligence may be considered the most promising tool for ADR improvement, provided that endoscopists education and recording are guaranteed.
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Affiliation(s)
- Alessandro Gubbiotti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Marco Spadaccini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Matteo Badalamenti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
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12
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Auriemma F, Sferrazza S, Bianchetti M, Savarese MF, Lamonaca L, Paduano D, Piazza N, Giuffrida E, Mete LS, Tucci A, Milluzzo SM, Iannelli C, Repici A, Mangiavillano B. From advanced diagnosis to advanced resection in early neoplastic colorectal lesions: Never-ending and trending topics in the 2020s. World J Gastrointest Surg 2022; 14:632-655. [PMID: 36158280 PMCID: PMC9353749 DOI: 10.4240/wjgs.v14.i7.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/02/2021] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer screening. In the world there are different approaches to the topic of colorectal cancer prevention and screening: different starting ages (45-50 years); different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests; recto-sigmoidoscopy; and colonoscopy. The key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination, experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination, knowledge in the field of resection of these lesions (from cold-snaring, through endoscopic mucosal resection and endoscopic submucosal dissection, up to advanced tools), and management of complications.
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Affiliation(s)
- Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento 38014, Italy
| | - Mario Bianchetti
- Digestive Endoscopy Unit, San Giuseppe Hospital - Multimedica, Milan 20123, Italy
| | - Maria Flavia Savarese
- Department of Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo 18038, Italy
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Nicole Piazza
- Gastroenterology Unit, IRCCS Policlinico San Donato, San Donato Milanese; Department of Biomedical Sciences for Health, University of Milan, Milan 20122, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico “G. Giaccone", Palermo 90127, Italy
| | - Lupe Sanchez Mete
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Alessandra Tucci
- Department of Gastroenterology, Molinette Hospital, Città della salute e della Scienza di Torino, Turin 10126, Italy
| | | | - Chiara Iannelli
- Department of Health Sciences, Magna Graecia University, Catanzaro 88100, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit and Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano 20089, Italy
| | - Benedetto Mangiavillano
- Biomedical Science, Hunimed, Pieve Emanuele 20090, Italy
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese 21053, Italy
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13
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Efficacy and tolerability of a low-residue diet for bowel preparation: systematic review and meta-analysis. Surg Endosc 2022; 36:3858-3875. [PMID: 34471982 DOI: 10.1007/s00464-021-08703-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/23/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) contributes significantly to cancer mortality worldwide. In an effort to reduce the risk of death, detection of polyps through colonoscopy is crucial. The success of the colonoscopy depends on the diet administered the day before the test. Our aim was to evaluate the efficacy, tolerability, and adverse effects of bowel preparation when using a low-residual diet (LRD) compared to a clear-liquid diet (CLD) the day before a scheduled colonoscopy. METHODS PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched. We included studies of patients undergoing a scheduled colonoscopy for CRC screening and surveillance or for diagnostic purposes that compared a LRD with a CLD the day before the colonoscopy. Efficacy, the primary outcome, was evaluated as the rate of adequate bowel preparation. Secondary outcomes were tolerability and adverse effects of bowel preparation. RESULTS Thirteen RCTs (N = 2587) were included. Patients receiving a LRD compared to a CLD showed no difference in adequate bowel preparations (RR 1.02; 95% CI 0.99-1.05; I2 = 60%). However, the LRD improved patient tolerability (RR 1.17; 95% CI 1.12-1.23; I2 = 66%) and had fewer adverse effects (RR 0.89; 95% CI 0.84-0.94; I2 = 73%) compared to the CLD. Groups using a LRD with 4L of polyethylene glycol in a single dose or a LRD with < 2000 kcal < 32 g of fibres/day had better tolerability. CONCLUSION Based on these findings, our recommendation is strong in favour of a LRD for bowel preparation of patients undergoing a scheduled colonoscopy. This diet could also be useful as a preoperative colonic preparation, but this requires further research.
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14
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Adamek HE, Bergmann L, Müssig K. [Bowel preparation in patients with Diabetes mellitus: Development of a procedure model]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:784-789. [PMID: 35545113 DOI: 10.1055/a-1791-1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adequate bowel preparation prior to colonoscopy is the key factor for high quality preparation for colonoscopy. Inadequate preparation can result in prolonged procedure time, incomplete colonoscopy and an increased risk of procedural adverse events. Diabetes mellitus has been identified as a predictor of inadequate colonoscopy bowel preparation. Currently, standard recommendations for diabetes patients before colonoscopy are missing. METHODS This review is based on a selective literature search in PubMed and Google Scholar carried out in June 2021. Systematic reviews, guidelines, expert opinions, and recommendations from German and international societies were also considered. RESULTS The currently available preparations comprise two different groups: High-, medium- and low- volume polyethylene glycol (PEG) preparations and hyperosmotic agents. So far, a couple of reviews tried to identify outcome related differencies. Results are heterogeneous. In practise, preparation agents and timing of preparation as well as a thorough patient information before the preparation process are considered the most relevant items. In diabetes patients, preinterventional dietary recommendations are of paramount importance. CONCLUSION Split dosing of PEG preparations are recommended in diabetes patients with expected motility disorders. Extensive counseling about preparation intake and dietary recommendations should be offered.
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Affiliation(s)
| | - Laura Bergmann
- Med. Klinik 2, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Karsten Müssig
- Klinik für Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken GmbH, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
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15
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Kelly L. Colonoscopy: an evidence-based approach. Nurs Stand 2022; 37:77-82. [PMID: 35257537 DOI: 10.7748/ns.2022.e11901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
Colonoscopy is an invasive, endoscopic procedure undertaken to visualise the inner lumen of the colon and is used for a variety of diagnostic purposes. The procedure is increasingly performed by nurse endoscopists. This article provides an overview of the indications and contraindications for colonoscopy and describes various elements of the procedure, including consent, sedation and bowel preparation within the context of the evidence base. The article also discusses patient care before, during and after the procedure.
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Affiliation(s)
- Lucy Kelly
- endoscopy department, Burnley General Hospital, East Lancashire Hospital NHS Trust, Burnley, Lancashire, England
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16
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Yeh J, Wu T, Hsiao P, Perng D, Chen J, Lo G, Hsu C, Lin C. A single‐center retrospective study comparing 1‐day and 3‐day low‐residue diets for bowel preparation. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jen‐Hao Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Hospital/I‐shou University Kaohsiung Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Dachang Hospital Kaohsiung Taiwan
- Department of Medical Technology College of Medicine, I‐Shou University Kaohsiung Taiwan
| | - Tsung‐Chin Wu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Hospital/I‐shou University Kaohsiung Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Dachang Hospital Kaohsiung Taiwan
- Department of Medical Technology College of Medicine, I‐Shou University Kaohsiung Taiwan
| | - Po‐Jen Hsiao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Hospital/I‐shou University Kaohsiung Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Dachang Hospital Kaohsiung Taiwan
| | - Daw‐Shyong Perng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Hospital/I‐shou University Kaohsiung Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Dachang Hospital Kaohsiung Taiwan
| | - Jen‐Chieh Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Dachang Hospital Kaohsiung Taiwan
| | - Gin‐Ho Lo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Hospital/I‐shou University Kaohsiung Taiwan
| | - Chia‐Chang Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Hospital/I‐shou University Kaohsiung Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Dachang Hospital Kaohsiung Taiwan
| | - Chih‐Wen Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Hospital/I‐shou University Kaohsiung Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine E‐DA Dachang Hospital Kaohsiung Taiwan
- School of Medicine, College of Medicine, I‐Shou University Kaohsiung Taiwan
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17
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van Riswijk MLM, van Keulen KE, Siersema PD. Efficacy of ultra-low volume (≤1 L) bowel preparation fluids: Systematic review and meta-analysis. Dig Endosc 2022; 34:13-32. [PMID: 33991373 PMCID: PMC9290948 DOI: 10.1111/den.14015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS High-quality bowel preparation is paramount for the diagnostic accuracy and safety of colonoscopy; however, it is often difficult for patients to adhere to high-volume laxatives, which may contribute to poor bowel preparation. This review aims to assess the efficacy of bowel preparation fluids of 1 L or less (≤1 L). METHODS We performed a systematic review including all relevant randomized controlled trials on ultra-low volume (≤1 L) bowel preparation fluids for colonoscopy published since 2015. Primary endpoint was the percentage of adequately prepared patients. Secondary endpoints included adenoma detection rate (ADR) and safety. RESULTS Bowel preparation with sodium picosulfate/magnesium citrate (SPMC; 19 trials, n = 10,287), 1L-polyethylene glycol with ascorbate (PEGA; 10 trials, n = 1717), sodium phosphate (NaP; 2 trials, n = 621), and oral sulfate solution (OSS; 3 trials, n = 597) was adequate in 75.2%, 82.9%, 81.9%, and 92.1%, respectively, of patients; however, heterogeneity between studies was considerable (I2 range: 86-98%). Pooled ADRs were 31.1% with SPMC, 32.3% with 1L-PEGA, 30.4% with NaP, and 40.9% with OSS. Temporary electrolyte changes were seen with all ultra-low volume bowel preparation fluid solutions but without sustained effects in most patients. CONCLUSION Ultra-low volume bowel preparation fluids do not always meet the 90% quality standard for adequate bowel preparation as defined by current guidelines. Nonetheless, they may be considered in patients intolerant for higher-volume laxatives and without risk factors for inadequate bowel preparation or dehydration-related complications.
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Affiliation(s)
- Milou L. M. van Riswijk
- Department of Gastroenterology and HepatologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Kelly E. van Keulen
- Department of Gastroenterology and HepatologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and HepatologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
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18
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Afecto E, Ponte A, Fernandes S, Gomes C, Correia JP, Carvalho J. Validation and Application of Predictive Models for Inadequate Bowel Preparation in Colonoscopies in a Tertiary Hospital Population. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 30:134-140. [PMID: 37008528 PMCID: PMC10050840 DOI: 10.1159/000520905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022]
Abstract
Background: Bowel preparation is a major quality criterion for colonoscopies. Models developed to identify patients with inadequate preparation have not been validated in external cohorts. We aim to validate these models and determine their applicability. Methods: Colonoscopies between April and November 2019 were retrospectively included. Boston Bowel Preparation Scale ≥2 per segment was considered adequate. Insufficient data, incomplete colonoscopies, and total colectomies were excluded. Two models were tested: model 1 (tricyclic antidepressants, opioids, diabetes, constipation, abdominal surgery, previous inadequate preparation, inpatient status, and American Society of Anesthesiology [ASA] score ≥3); model 2 (co-morbidities, tricyclic antidepressants, constipation, and abdominal surgery). Results: We included 514 patients (63% males; age 61.7 ± 15.6 years), 441 with adequate preparation. The main indications were inflammatory bowel disease (26.1%) and endoscopic treatment (24.9%). Previous surgery (36.2%) and ASA score ≥3 (23.7%) were the most common comorbidities. An ASA score ≥3 was the only identified predictor for inadequate preparation in this study (p < 0.001, OR 3.28). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of model 1 were 60.3, 64.2, 21.8, and 90.7%, respectively. Model 2 had a sensitivity, specificity, PPV, and NPV of 57.5, 67.4, 22.6, and 90.5%, respectively. The AUC for the ROC curves was 0.62 for model 1, 0.62 for model 2, and 0.65 for the ASA score. Conclusions: Although both models accurately predict adequate bowel preparation, they are still unreliable in predicting inadequate preparation and, as such, new models, or further optimization of current ones, are needed. Utilizing the ASA score might be an appropriate approximation of the risk for inadequate bowel preparation in tertiary hospital populations.
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19
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Di Leo M, Iannone A, Arena M, Losurdo G, Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A. Novel frontiers of agents for bowel cleansing for colonoscopy. World J Gastroenterol 2021; 27:7748-7770. [PMID: 34963739 PMCID: PMC8661374 DOI: 10.3748/wjg.v27.i45.7748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’ acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’ tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.
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Affiliation(s)
- Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Monica Arena
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Pierluigi Consolo
- Unit of Digestive Endoscopy, University of Messina, Hospital "G. Martino", Messina 98121, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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20
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Tian X, Yi LJ, Han Y, Chen H, Liu XL, Chen WQ, Jiménez-Herrera MF. Comparative Effectiveness of Enhanced Patient Instructions for Bowel Preparation Before Colonoscopy: Network Meta-analysis of 23 Randomized Controlled Trials. J Med Internet Res 2021; 23:e19915. [PMID: 34694227 PMCID: PMC8576559 DOI: 10.2196/19915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/13/2020] [Accepted: 03/22/2021] [Indexed: 01/30/2023] Open
Abstract
Background Various enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis also demonstrated the efficacy of EPIs in increasing the colonic polyp and adenoma detection rates; however, the optimal method for adequate BP has not yet been developed. Objective We performed a network meta-analysis to determine the optimal instructions. Methods We searched for randomized controlled trials (RCTs) comparing the effectiveness of EPIs with each other or standard patient instructions (SPIs) for BP. We performed direct and Bayesian network meta-analyses for all instructions and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria to appraise the quality of evidence. Results We included 23 RCTs (7969 patients) comparing 10 different instructions. In direct meta-analyses, most of the EPIs, except visual aids and mobile apps, increased the adequate preparation rate (APR). Network meta-analyses showed that additional explanations were superior to visual aids (odds ratio [OR] 0.35, 95% CI 0.19-0.59), telephone calls (OR 0.62, 95% CI 0.37-0.99), educational videos (OR 0.79, 95% CI 0.5-0.77), and mobile apps (OR 0.33, 95% CI 0.14-0.68) with low-to-high-quality evidence; newly designed booklets (OR 3.28, 95% CI 1.59-6.16), SMS text messaging (OR 2.33, 95% CI 1.28-3.91), telephone calls (OR 1.86, 95% CI 1.03-1.78), educational videos (OR 2.33, 95% CI 1.40-3.65), and social media applications (OR 2.42, 95% CI 1.4-3.93) were superior to visual aids and mobile apps with low-to-high-quality evidence. SMS text messaging, telephone calls, and social media applications increase adherence to and satisfaction with the BP regime. Social media applications reduce the risk of adverse events (AEs). Telephone calls and social media applications increase the polyp detection rate (PDR). Conclusions Newly designed booklets, telephone calls, educational videos, and social media applications can improve the quality of BP. Telephone calls and social media applications improve adherence to and satisfaction with the BP regime, reduce the risk of AEs, and increase the PDR. Trial Registration INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/
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Affiliation(s)
- Xu Tian
- Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain
| | - Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Yang Han
- Chongqing University Cancer Hospital, Chongqing, China
| | - Hui Chen
- Chongqing University Cancer Hospital, Chongqing, China
| | - Xiao-Ling Liu
- Chongqing University Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Chongqing University Cancer Hospital, Chongqing, China
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21
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Archer T, Shirazi-Nejad AR, Al-Rifaie A, Corfe BM, Riley S, Thoufeeq M. Is it time we split bowel preparation for all colonoscopies? Outcomes from a national survey of bowel preparation practice in the UK. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000736. [PMID: 34610925 PMCID: PMC8493910 DOI: 10.1136/bmjgast-2021-000736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/08/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction Adequate bowel preparation is a prerequisite for effective colonoscopy. Split bowel preparation results in optimal cleansing. This study assessed the bowel preparation regimes advised by endoscopy units across the UK, and correlated the differences with outcomes. Methods Trusts in the UK were surveyed, with data requested between January 2018 and January 2019, including: the type and timing of preparation, pre-endoscopy diet, adequacy rates and polyp detection. Trusts were grouped according to the timing of bowel preparation. χ2 test was used to assess for differences in bowel preparation adequacy. Results Moviprep was the first line bowel preparation in 79% of trusts. Only 7% of trusts advised splitting bowel preparation for all procedures, however, 91% used split bowel preparation for afternoon procedures. Trusts that split preparation for all procedures had an inadequacy rate of 6.7%, compared with 8.5% (p<0.001) for those that split preparation for PM procedures alone and 9.5% (p<0.001) for those that provided day before preparation for all procedures. Morning procedures with day-before preparation had a higher rate of inadequate cleansing than afternoon procedures that received split preparation (7.7% vs 6.5 %, p<0.001). The polyp detection rate for procedures with adequate preparation was 37.1%, compared with 26.4% for those that were inadequate. Conclusion Most trusts in the UK do not provide instructions optimising the timing of bowel preparation prior to colonoscopy. This correlated with an increased rate of inadequate cleansing. Splitting bowel preparation is likely to reduce the impacts of poor cleansing: missed lesions, repeat colonoscopies and significant costs.
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Affiliation(s)
- Thomas Archer
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK .,Molecular Gastroenterology Research Group, Department of Oncology & Metabolism, The University of Sheffield, Sheffield, UK
| | - Ahmad Reza Shirazi-Nejad
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ammar Al-Rifaie
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bernard M Corfe
- Population and Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart Riley
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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22
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de Sousa Magalhães R, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. The Prediction of Inadequate Colon Capsule Cleansing: A Cohort Selection Guided by CC-CLEAR. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 29:311-321. [PMID: 36159193 PMCID: PMC9485925 DOI: 10.1159/000518588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
Introduction 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. Aim To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report). Methods 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. Results We included 167 consecutive colon capsules. Sixty-eight percent (n = 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], p value < 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], p value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], p value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], p 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], p value < 0.001). Conclusion 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.
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Affiliation(s)
- Rui de Sousa Magalhães
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
- * Rui de Sousa Magalhães,
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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23
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Wu R, Ji WY, Yang C, Zhan Q. A Systematic Review and Meta-Analysis of Low-Residue Diet Versus Clear Liquid Diet: Which Is Better for Bowel Preparation Before Colonoscopy? Gastroenterol Nurs 2021; 44:341-352. [PMID: 34238885 PMCID: PMC8478318 DOI: 10.1097/sga.0000000000000554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/08/2020] [Indexed: 11/25/2022] Open
Abstract
The goal of this systematic review was to compare the clear liquid diet and the low-residue diet to determine which is better for bowel preparation before colonoscopy. A literature search for randomized controlled trials on the effects of employing the clear liquid diet and low-residue diets before colonoscopy was conducted in major online English databases (PubMed, Web of Science, and Ovid EMBASE). After the systematic review of all 16 studies, the outcomes including quality of bowel preparation, tolerance, willingness to repeat, and adverse effects were analyzed through meta-analysis. The statistical analysis was performed by using RevMan 5.3 software. No statistically significant difference was observed between the low-residue diet and clear liquid diet groups (odds ratio [95% confidence interval] = 1.19 [0.79, 1.81]; p = .41). There was no statistically significant difference between the Boston Bowel Preparation Scale (standard mean difference [95% confidence interval] =-0.04 [-0.21, -0.14]; p = .68) Ottawa Bowel Preparation Scale (standard mean difference [95% confidence interval] =-0.04 [-0.19, 0.11]; p = .59) scores of the two groups. The quality indicators for colonoscopy of the two groups were not statistically significant. However, patient tolerance to the low-residue diet was higher (odds ratio [95% confidence interval] = 1.86 [1.47, 2.36]; p < .01). More patients in the low-residue diet group were willing to repeat the low-residue diet for bowel preparation (odds ratio [95% confidence interval] = 2.34 [1.72, 3.17]; p < .01). More patients in the clear liquid diet group experienced hunger, nausea, and vomiting. People who employed the low-residue diet before colonoscopy had the same quality of bowel preparation as those with clear liquid diet. Meanwhile, the tolerance of people with low-residue diet was better than people with clear liquid diet, and these people were more willing to repeat the colonoscopy with less adverse events.
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Affiliation(s)
- Rui Wu
- Rui Wu, MD, is a student, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, China, and Department of Digestive Endoscopy, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Wen-ya Ji, MD, is a student, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, China
- Cheng Yang, MD, PhD, is a visiting staff, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, China
- Qiang Zhan, MD, PhD, is an archiater, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Wen-ya Ji
- Rui Wu, MD, is a student, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, China, and Department of Digestive Endoscopy, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Wen-ya Ji, MD, is a student, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, China
- Cheng Yang, MD, PhD, is a visiting staff, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, China
- Qiang Zhan, MD, PhD, is an archiater, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Cheng Yang
- Correspondence to: Cheng Yang, MD, PhD or Qiang Zhan, MD, PhD, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, 299 Qingyang Road, Wuxi 214023, Jiangsu, China ( or )
| | - Qiang Zhan
- Correspondence to: Cheng Yang, MD, PhD or Qiang Zhan, MD, PhD, Department of Gastroenterology, The Affiliated Wuxi People's Hospital to Nanjing Medical University, 299 Qingyang Road, Wuxi 214023, Jiangsu, China ( or )
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24
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Machlab S, Martínez-Bauer E, López P, Piqué N, Puig-Diví V, Junquera F, Lira A, Brullet E, Selva A, García-Iglesias P, Calvet X, Campo R. Comparable quality of bowel preparation with single-day versus three-day low-residue diet: Randomized controlled trial. Dig Endosc 2021; 33:797-806. [PMID: 33015912 DOI: 10.1111/den.13860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS There is controversy about the length of low-residue diet (LRD) for colonoscopy preparation. The aim of the study was to compare one-day vs. three-day LRD associated to standard laxative treatment for achieving an adequate colonoscopy preparation in average risk subjects with positive fecal immunochemical test undergoing screening colonoscopy. METHODS A non-inferiority, randomized, controlled, parallel-group clinical trial was performed in the setting of average risk colorectal cancer screening program. Participants were randomized to receive 1-day vs. 3-day LRD in addition to standard polyethilenglicol treatment. Adequacy of preparation was evaluated using the Boston Bowel Preparation Scale (BBPS). Primary outcome was achieving a BBPS ≥ 2 in all colon segments. Analysis was performed for a non-inferiority margin of 5%, a 95% statistical power and one-sided 0.05 significance level. RESULTS A total of 855 patients were randomized. Adequate bowel preparation was similar between groups: 97.9% of patients in the 1-day LRD group vs 96.9% in the 3-day LRD group achieved the primary outcome (P-value for non-inferiority < 0.001). The percentage of patients with BBPS scores ≥ 8 was superior in the 1-day LRD group (254 vs 221 in the 3-day LRD group, P = 0.032). The 1-day regimen was better tolerated than the 3-day diet. 47.7% (vs 28.7%, P < 0.05) of patients rated the 1-day LRD as very easy to follow. CONCLUSION The 1-day LRD is non-inferior to 3-day LRD for achieving an adequate colon cleansing before average risk screening colonoscopy and it is better tolerated.
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Affiliation(s)
- Salvador Machlab
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Martínez-Bauer
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Núria Piqué
- Microbiology Section, Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Sciences, Universitat de Barcelona (UB), Barcelona, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentària de la UB (INSA-UB), Universitat de Barcelona (UB), Barcelona, Spain
| | - Valentí Puig-Diví
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Félix Junquera
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Lira
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Enric Brullet
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Anna Selva
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Pilar García-Iglesias
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Xavier Calvet
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafel Campo
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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25
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Impact of Prepackaged Low-Residue Diet on Bowel Preparation for Colonoscopy: A Meta-analysis. Gastroenterol Nurs 2021; 44:E29-E37. [PMID: 33795626 DOI: 10.1097/sga.0000000000000588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/13/2021] [Indexed: 01/08/2023] Open
Abstract
This meta-analysis aimed to evaluate the impact of prepackaged low-residue diet (PLRD) on bowel preparation for colonoscopy. We searched PubMed, Web of Science, EMBASE, and Cochrane Library databases from inception to August 2020. Randomized controlled trials (RCTs) comparing PLRD with clear liquid diet (CLD) or self-prepared LRD were considered for inclusion. The analysis calculated the odds ratio (OR) for the rate of adequate bowel preparation, patient tolerance, willingness to repeat bowel preparation, tolerability of bowel preparation, and overall adverse effects. Five RCTs published between 2006 and 2019 (N = 561) were included in our meta-analysis. Compared with the traditional CLD or self-prepared LRD, PLRD showed significantly higher rates of adequate bowel preparation (OR, 2.16; 95% confidence interval [CI], 1.18-3.98; p = .01), patient tolerance (OR, 1.99; 95% CI, 1.30-3.07; p = .002), and willingness to repeat the bowel preparation (OR, 1.68; 95% CI, 1.05-2.70; p = .03), with no differences in adverse events (OR, 0.93; 95% CI, 0.59-1.46; p = .75). Prepackaged low-residue diet improved bowel preparation quality, patient tolerance, and willingness to repeat bowel preparations. Importantly, PLRD does not increase the incidence of adverse events. This suggests that it is effective and safe to use PLRD for bowel preparation before colonoscopy.
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26
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Abstract
Colonoscopy is an important diagnostic and therapeutic tool in evaluating and treating gastrointestinal tract pathologies. Adequate visualization of the intestinal lumen is necessary for detection of lesions, and thus bowel preparation is a key component of the process. It is estimated that over 25% percent of pediatric patients have sub-optimal bowel preparations, which can lead to longer procedure times, missed pathology, unsuccessful ileal intubation, and possibly repeat procedure/anesthesia. There is no universal protocol for bowel preparation in pediatrics and there is a wide variability of practices around the world. The purpose of this paper is to review the recent published literature regarding bowel preparations for pediatric colonoscopy with focus on published work in the last decade exploring a number of factors involved in bowel preparation including the role of patient education, types of bowel preparation, and their efficacy and safety.
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Affiliation(s)
- Petar Mamula
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Noor Nema
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
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27
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Chen E, Chen L, Wang F, Zhang W, Cai X, Cao G. Low-residue versus clear liquid diet before colonoscopy: An updated meta-analysis of randomized, controlled trials. Medicine (Baltimore) 2020; 99:e23541. [PMID: 33285772 PMCID: PMC7717789 DOI: 10.1097/md.0000000000023541] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Great value in the early identification and treatment of adenomatous polyps or early canceration using colonoscopy has been recognized. A clear colonoscopic vision brought by good intestinal preparation will become crucial. Several studies have completed using the low-residue diet (LRD) versus a clear liquid diet (CLD) the day before colonoscopy that presenting contradictory results. Therefore, a more comprehensive and updated meta-analysis is needed to summarize the findings on the effects of LRD and CLD on intestinal preparation and the quality of coloscopy.The comprehensive search was performed in PubMed/MEDLINE, Scopus, Cochrane databases (February 2020). LRD vs CLD before colonoscopy were included in this study. Mantel-Haenszel or DerSimonian and Laird models with the relative risk (RR) to evaluate differences in intestinal preparation, tolerance, readiness to repeat preparation, detected of a polyp, and overall adverse reactions.Total 16 studies (N = 3413) were eligible. Patients with LRD compared with CLD indicated significantly better of tolerability (RR 0.92;95% CI,0.85-0.99; P < .05) and willingness to repeat intestinal preparation (RR 0.86; 95% CI 0.79-0.93; P < .05), but no differences with adequate intestinal preparations, detected polyp or overall adverse reactions (all P > .05).Patients with LRD the day before colonoscopy show better tolerance and willingness to repeat intestinal preparation, and no difference with adequate intestinal preparations compared with CLD, but the recommended level of evidence is weak. However, in terms of the detection rate of intestinal adenomas, the LRD group is not weaker than the CLD group, for its evidence level is high, and can significantly reduce the hunger experience of patients.
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Affiliation(s)
- Engeng Chen
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Li Chen
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Fei Wang
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Wei Zhang
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Xianlei Cai
- Department of General Surgery, Ningbo Medical Center of Li Hui Li Hospital
| | - Gaoyang Cao
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
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28
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Han A, Maratt J, Kahi C. Colorectal Cancer Screening Decisions in the Opportunistic Setting. Gastrointest Endosc Clin N Am 2020; 30:413-422. [PMID: 32439079 DOI: 10.1016/j.giec.2020.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer incidence and mortality have decreased in the United States in recent decades, largely through opportunistic screening. Although certain organizations have improved internal screening rates by implementing programmatic screening, most of the United States undergoes opportunistic screening. Much effort and resources have been expended comparing screening tests to determine the most effective; however, deeper analysis of the US population has revealed subsets of ethnicities may be grossly underscreened. The most effective screening test remains the test that is completed and adhered to, and a better question may concern the best method of discussing screening.
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Affiliation(s)
- Andrew Han
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN 46202, USA.
| | - Jennifer Maratt
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN 46202, USA; Richard L. Roudebush VA Medical Center, 1481 West 10th Street, 111G, Indianapolis, IN 46202, USA
| | - Charles Kahi
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN 46202, USA; Richard L. Roudebush VA Medical Center, 1481 West 10th Street, 111G, Indianapolis, IN 46202, USA
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29
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Tian X, Xu LL, Liu XL, Chen WQ. Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials. JMIR Mhealth Uhealth 2020; 8:e17372. [PMID: 32347798 PMCID: PMC7296415 DOI: 10.2196/17372] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/13/2020] [Accepted: 02/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background To improve patients’ comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas. Objective This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas. Methods We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes. Results We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95% CI 1.05-1.35; P<.05; I2=42%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95% CI 1.15-1.64; P<.001; I2=0%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95% CI 1.22-2.53; P<.05; I2=0%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively. Conclusions The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data.
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Affiliation(s)
- Xu Tian
- Chongqing University Cancer Hospital, Chongqing, China
| | - Ling-Li Xu
- Chongqing University Cancer Hospital, Chongqing, China
| | - Xiao-Ling Liu
- Chongqing University Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Chongqing University Cancer Hospital, Chongqing, China
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30
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Ramprasad C, Ng S, Zhang Y, Liang PS. Low-residue diet for colonoscopy in veterans: Risk factors for inadequate bowel preparation and patient satisfaction and compliance. PLoS One 2020; 15:e0233346. [PMID: 32437378 PMCID: PMC7241790 DOI: 10.1371/journal.pone.0233346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/03/2020] [Indexed: 01/10/2023] Open
Abstract
Bowel preparation with low-residue diet (LRD) has resulted in higher patient satisfaction and similar polyp detection rates compared to conventional clear liquid diet. However, there is limited experience with LRD in veterans, in whom conditions associated with poor bowel preparation are more prevalent than the general population. To examine risk factors associated with inadequate bowel preparation, we conducted a chart review of outpatient colonoscopies at the Manhattan VA Medical Center from February 2017 to April 2018. To examine patient satisfaction and compliance, we administered an anonymous questionnaire to patients undergoing outpatient colonoscopy from March to August 2018. Patients assessed by chart review (n = 660) were 92% male with a mean age of 64 years. An adequate Boston Bowel Preparation Scale score ≥2 in each colonic segment was achieved in 94% of procedures. Higher BMI, diabetes, prior inadequate bowel preparation, bowel preparation duration of two days, and opioid use were associated with inadequate bowel preparation on univariable analysis. On multiple logistic regression, only higher BMI remained a predictor, with every one-unit increase associated with a 6% increased odds of poor bowel preparation. Questionnaire responses showed 84% of patients were willing to repeat LRD bowel preparation, 85% found the process easy or acceptable, and 78% reported full adherence to LRD. These findings demonstrate that bowel preparation quality, patient satisfaction, and compliance were all high among veterans using LRD.
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Affiliation(s)
- Chethan Ramprasad
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Sandy Ng
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Yian Zhang
- Division of Biostatistics, Department of Population Health and Environmental Medicine, NYU Langone Health, New York, New York, United States of America
| | - Peter S. Liang
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
- Department of Medicine, VA New York Harbor Health Care System, New York, New York, United States of America
- * E-mail:
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Millien VO, Mansour NM. Bowel Preparation for Colonoscopy in 2020: A Look at the Past, Present, and Future. Curr Gastroenterol Rep 2020; 22:28. [PMID: 32377915 DOI: 10.1007/s11894-020-00764-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF THIS REVIEW Colorectal cancer is the third most common cancer in the USA. Colonoscopy is considered the gold standard for colorectal cancer screening and can offer both diagnosis and therapy. The bowel preparation remains a significant barrier for patients who need to undergo colonoscopy and is often cited as the most dreaded aspect of the colonoscopy process. Inadequate bowel preparations still occur in 10-25% of colonoscopies, and this in turn can lead to increased procedural times, lower cecal intubation rates, and shorter interval between colonoscopies. From a quality standpoint, it is imperative that we do what we can to decrease the rate of inadequate bowel preparations. This review will focus on recent data regarding bowel preparation and offers a glimpse into what may be coming in the future. RECENT FINDINGS Recent advances in the field have been made to improve tolerability of bowel preparations and allow for more adequate colonoscopies. Newer, lower volume, flavored preparations, the use of adjuncts, and using split-dose preparations all can help with tolerability, compliance, and, in turn, preparation quality. Edible bowel preparations may become available in the near future. Early data on the use of artificial intelligence for assessment of preparation quality has been promising. Additionally, utilization of smartphone technology for education prior to the bowel preparation has also been shown to improve the adequacy of bowel preparations. CONCLUSIONS Ongoing efforts to improve the tolerability and palatability of colonoscopy bowel preparations are important from a quality improvement standpoint to ensure the adequacy of colonoscopy. Incorporating patient-specific factors and comorbidities is also an essential aspect of improving the quality of bowel preparation. Leveraging technology to better communicate with and educate patients on the bowel preparation process is likely to play a larger role in the coming years.
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Affiliation(s)
- Valentine Ongeri Millien
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge St., Suite 8B, Houston, TX, 77030, USA
| | - Nabil M Mansour
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge St., Suite 8B, Houston, TX, 77030, USA.
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Jiao L, Wang J, Zhao W, Zhu X, Meng X, Zhao L. Comparison of the effect of 1-day and 2-day low residue diets on the quality of bowel preparation before colonoscopy. Saudi J Gastroenterol 2020; 26:137-143. [PMID: 32270774 PMCID: PMC7392293 DOI: 10.4103/sjg.sjg_471_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND/AIM Low residue diet (LRD) has a similar quality of bowel preparation with clear liquid diet before colonoscopy, but improved patient tolerance. However, the optimal LRD duration is still controversial. In this study, we have compared the effect of a 1-day LRD and 2-day LRD on the quality of bowel preparation and patient tolerance. PATIENTS AND METHODS Our prospective, randomized, single-blind trial, single-blind, trial compared two dietary regimens administered the day before colonoscopy. All patients were administered PEG-ES and simethicone for bowel preparation. The primary outcome measure was bowel preparation quality. The secondary outcome measures were insertion time, withdrawal time, polyp detection rate, patient tolerance, and willingness to use the same diet for bowel preparation again. Bowel preparation quality was evaluated using the Boston bowel preparation scale (BBPS). Patient tolerance was evaluated using a hunger-comfort scale. RESULTS There was no significant difference in bowel preparation quality between the 2 groups. The 1-day LRD group had a BBPS score of 6.48 ± 1.59 points, while the 2-day LRD group had a score of 6.42 ± 1.06 points (P > 0.05). The groups reported similar colonoscope insertion times, withdrawal times, polyp detection rates and patient tolerance scores (hunger-comfort scores). The numbers of patients who reported that compliance as easy or very easy were 126 (78.2%) in the 1-day group versus 88 (55.0%) in the 2 day group (P < 0.05) and the numbers who were willing to use the diet again in the future were 154 (95.7%) in the 1-day group versus 131 (81.9%) in the 2 day group (P < 0.05). CONCLUSION LRD duration (1 day or 2 days) had no significant effect on bowel preparation quality. Patients in the 1-day LRD group had higher tolerance and satisfaction levels than patients in the 2-day LRD group. However, overall satisfaction was higher with the 1-day LRD group than with the 2-day LRD group.
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Affiliation(s)
- Li Jiao
- Department of Gastroenterology, The Third Hospital of Hebei Medical University, Shijiazhuang, China,Address for correspondence: Dr. Li Jiao, #139 Ziqiang Road, Shijiazhuang, Hebei - 050000, China. E-mail:
| | - Junmin Wang
- Department of Gastroenterology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenjuan Zhao
- Department of Gastroenterology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinying Zhu
- Department of Gastroenterology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xia Meng
- Department of Gastroenterology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liwei Zhao
- Department of Gastroenterology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Jacobson BC, Calderwood AH. Measuring bowel preparation adequacy in colonoscopy-based research: review of key considerations. Gastrointest Endosc 2020; 91:248-256. [PMID: 31568770 DOI: 10.1016/j.gie.2019.09.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Brian C Jacobson
- Section of Gastroenterology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Audrey H Calderwood
- Division of Gastroenterology, Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire, USA
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Taveira F, Areia M, Elvas L, Alves S, Brito D, Saraiva S, Cadime AT. A 3-day low-fibre diet does not improve colonoscopy preparation results compared to a 1-day diet: A randomized, single-blind, controlled trial. United European Gastroenterol J 2019; 7:1321-1329. [PMID: 31839957 DOI: 10.1177/2050640619883176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/24/2019] [Indexed: 01/01/2023] Open
Abstract
Background Although a 1-day low-fibre diet before colonoscopy is currently recommended, some endoscopists prescribe a 3-day diet. Objective The objective of this study was to compare the influence of a 3-day versus a 1-day low-fibre diet on bowel preparation quality, patient tolerability and adherence. Methods Outpatients scheduled for total colonoscopy were randomized in two groups, 3-day versus 1-day low-fibre diet, performing a 4-litre polyethylene glycol split-dose. The primary outcome was a reduction of inappropriate preparations in the 3-day low-fibre diet arm from 15% to 5% (bowel preparation was assessed by the Boston Bowel Preparation Scale). Secondary outcomes were adherence to, difficulty to perform, difficulty to obtain and willingness to repeat the diet. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the primary outcome. Results A total of 412 patients were randomized (206 per group). Bowel preparation quality was similar between groups. On ITT analysis (n = 412), adequate bowel preparation was 91.7% (3-day diet) versus 94.7% (1-day diet), p = 0.24 and on PP analysis (n = 400) 93.5% versus 96.5%, respectively, p = 0.16. Difficulty to perform the diet was significantly higher on the 3-day diet, p = 0.04. No differences were found on difficulty to obtain the diet, willingness to repeat the diet, adverse events and intra-colonoscopy findings. Conclusion A 3-day low-fibre diet does not bring benefit to the bowel preparation quality and is harder to perform than a 1-day diet.
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Affiliation(s)
- Filipe Taveira
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Miguel Areia
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Elvas
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Susana Alves
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Daniel Brito
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Sandra Saraiva
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Ana T Cadime
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
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Hernández G, Gimeno-García AZ, Quintero E. Strategies to Improve Inadequate Bowel Preparation for Colonoscopy. Front Med (Lausanne) 2019; 6:245. [PMID: 31781565 PMCID: PMC6857107 DOI: 10.3389/fmed.2019.00245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022] Open
Abstract
Bowel cleansing is one of the most important parameters included in the evaluation of colonoscopy quality. The available evidence suggests that inadequate bowel preparation reduces the diagnostic yield of colorectal neoplasia and increases post-colonoscopy colorectal cancer risk. Nowadays, up to 30% of patients referred for colonoscopy have a poor bowel cleansing. Recently, several studies have analyzed the risk factors for inadequate bowel cleansing as well as the strategies to optimize bowel preparation. In this review, we have focused on summarizing the available evidence in this field.
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Affiliation(s)
- Goretti Hernández
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Antonio Z Gimeno-García
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Enrique Quintero
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.,Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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Randomized Controlled Trial: Split-dose and Same-day Large Volume Bowel Preparation for Afternoon Colonoscopy Have Similar Quality of Preparation. J Clin Gastroenterol 2019; 53:724-730. [PMID: 31021890 DOI: 10.1097/mcg.0000000000001213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
GOALS We compare bowel cleanliness in patients taking same-day versus split-dose 4-L polyethylene glycol laxative for afternoon colonoscopy. Secondary objectives included patient satisfaction, adverse effects and patient tolerability. BACKGROUND Afternoon colonoscopies have been associated with inadequate bowel preparation and lower adenoma detection rates. Same-day (morning) or split-dosing of the laxative have improved preparation quality but differences between these options are unclear. MATERIALS AND METHODS Single-center prospective randomized endoscopist blinded trial. Patients aged 18 years and above prescribed 4-L polyethylene glycol for colonoscopy were randomized into same-day or split-dose preparation. Preparation quality was assessed using the Ottawa Bowel Preparation Scale. Patient satisfaction and side effects was collected using a questionnaire. Intention-to-treat and per-protocol analysis were performed. RESULTS A total of 300 patients (158 split-dose, 142 same-day) were evaluated. No statistically significant difference was seen on total Ottawa score among the groups (P=0.47) or by individual colonic segments in intent-to-treat and per-protocol analysis. Patients in split-dose group were more likely to complete the entire preparation (P=0.01) but reported more sleep loss (P=0.001). The same-day preparation group reported higher incidence of vomiting (P=0.036). Patients ingesting bowel preparation ≥7 hours before colonoscopy had higher total Ottawa scores (P=0.001). CONCLUSIONS There were no differences in quality of preparation in patients taking same-day versus split-dose preparation for afternoon colonoscopy. Those receiving same-day preparation were less likely to lose sleep but more likely to have emesis. These differences should be considered when selecting a bowel preparation regimen.
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A low-residue diet before colonoscopy tends to improve tolerability by patients with no differences in preparation quality: a randomized trial. Surg Endosc 2019; 34:3037-3042. [PMID: 31482360 DOI: 10.1007/s00464-019-07100-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 08/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The pre-colonoscopy diet traditionally involves 24 h of a clear liquid diet (CLD) in combination with a lavage solution; however, this preparation is poorly tolerated. AIM To compare the impact on the quality of bowel cleansing and tolerability of a CLD versus a low-residue diet (LRD). METHODS We performed a randomized trial. Subjects were randomized to CLD or LRD the day before of elective colonoscopy. All subjects received a 4-L preparation of single-dose PEG beginning 16 h prior to colonoscopy. The Boston bowel preparation scale was used to evaluate bowel cleansing; an adequate-quality preparation was defined as a score ≥ 2 per segment. RESULTS A total of 205 subjects were included with a mean age (SD) of 55.6 (12.6) years; 133 (64.9%) of them were female. A total of 105 subjects were randomized to receive CLD and 100 to LRD. No significant differences in bowel preparation quality were observed between groups according to the section of colon: right colon (70% vs. 73%, p = 0.08), transverse colon (82% vs. 79%, p = 0.062), or left colon (80% vs. 78.7%, p = 0.28). There was a tendency toward less-frequent nausea (p = 0.08) and vomiting (p = 0.07) in patients with LRD. No differences between groups regarding ADR (12% vs. 10%) were noted. CONCLUSIONS An LRD before colonoscopy resulted in a tendency toward improved tolerability by patients, with no differences in the quality of bowel preparation.
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Özer Etik D, Suna N, Gündüz C, Bostan A, Özdemir A, Gürel BY, Yenişekerci E, Boyacıoğlu AS. Can a 1-day clear liquid diet with a split -dose polyethylene glycol overcome conventional practice patterns during the preparation for screening colonoscopy? TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:817-825. [PMID: 31258137 DOI: 10.5152/tjg.2019.19071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS A successful screening colonoscopy is closely linked to the quality of a bowel preparation. In this study, we aimed to determine the impact of a 1-day clear liquid diet (CLD) compared to a 3-day combined diet (CMD) accompanied by a split-dose regimen of polyethylene glycol and electrolyte lavage solution (PEG-ELS) for screening colonoscopy. MATERIALS AND METHODS This was a prospective, randomized, endoscopist-blinded study. Patients referred for screening colonoscopy were randomized to four groups as a 1-day CLD+PEG-ELS vs. a 1-day CLD+sulfate free (SF)-PEG-ELS and a 3-day CMD+PEG-ELS vs. a 3-day CMD+SF-PEG-ELS. An assessment of the quality of colon cleaning, tolerability to the preparation, and symptoms related to the preparation were recorded. RESULTS A total of 506 patients were enrolled in this study. The quality of bowel preparation was significantly inferior in the CMD+PEG-ELS group than CLD+PEG-ELS (p=0.004) and CMD+SF-PEG-ELS groups (p=0.007). There were no statistical differences among the groups in terms of the polyp detection rate. With respect to an easy rating of diet following and the consumption of laxative, there were no significant differences among the four groups. Gastric fullness and nausea/vomiting were pointed out much more, especially in the SF-PEG-ELS users (p=0.008 and p=0.004, respectively). CONCLUSION A 1-day CLD was not inferior to a 3-day CMD for colonoscopy preparation in terms of bowel cleaning, the polyp detection rate, and patient tolerance.
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Affiliation(s)
- Diğdem Özer Etik
- Department of Gastroenterology, Başkent University School of Medicine, Ankara, Turkey
| | - Nuretdin Suna
- Department of Gastroenterology, Başkent University School of Medicine, Ankara, Turkey
| | - Cemre Gündüz
- Department of Internal Disease, Başkent University School of Medicine, Ankara, Turkey
| | - Ahmet Bostan
- Başkent University School of Medicine, Ankara, Turkey
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Lee JW, Choi JY, Yoon H, Shin CM, Park YS, Kim N, Lee DH. Favorable outcomes of prepackaged low-residue diet on bowel preparation for colonoscopy: Endoscopist-blinded randomized controlled trial. J Gastroenterol Hepatol 2019; 34:864-869. [PMID: 30278110 DOI: 10.1111/jgh.14499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/15/2018] [Accepted: 09/19/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM 2 L polyethylene glycol plus an ascorbic acid (PEGA) is known to be as effective. However, 2 L polyethylene glycol-based regimens are often still difficult for patients to tolerate. Therefore, we conducted this study to evaluate the potential of 1 L PEGA with prepackaged low-residue diet (PLD) as an alternative to 2 L PEGA before colonoscopy. METHODS The subjects were randomly assigned to either of the two groups. The 2 L PEGA group received 2 L PEGA split regimen. The 1 L PEGA with PLD group received PLD on the day preceding colonoscopy and 1 L PEGA. All endoscopic procedures were performed by one physician who did not know patients allocation. Bowel preparation status were graded using Boston Bowel Preparation Score (BBPS). A questionnaire regarding tolerability and safety was administered. This trial is registered at ClinicalTrials.gov (NCT03329339). RESULTS A total of 173 patients completed the study (86 in the 2 L PEGA group and 87 in the 1 L PEGA with PLD group). Bowel preparation was adequate in 88.4% (76/86) of patients in the 2 L PEGA group and 93.1% of patients in the 1 L PEGA with PLD group (81/87, P = 0.28). The patients in the 1 L PEGA with PLD group had higher whole Boston Bowel Preparation Scale score (P = 0.02) and expressed more satisfaction and willingness to repeat the procedure (P < 0.01). There was no significant difference with respect to compliance or safety. CONCLUSION 1 L PEGA with PLD showed equivalent efficacy, greater satisfaction, and more willingness to repeat compared with 2 L PEGA for bowel preparation.
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Affiliation(s)
- Jung Won Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joon Young Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Strategies to optimise the quality of bowel cleansing. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:326-338. [PMID: 31027972 DOI: 10.1016/j.gastrohep.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/17/2022]
Abstract
Colonoscopy is the gold standard procedure for detecting neoplastic lesions of the colon and its efficiency is closely linked to the quality of the procedure. Adequate bowel preparation is a crucial factor in achieving the recommended quality indicators, but poor preparation has been reported in up to 30% of outpatients referred for colonoscopy. Consequently, over recent years, a number of studies have developed strategies to optimise bowel cleansing by improving adherence and tolerance to and the efficacy of the bowel preparation. Moreover, the identification of risk factors for inadequate bowel cleansing has led to tailored bowel preparation strategies being designed, with promising results. We aimed to review studies that assessed risk factors for inadequate bowel preparation and strategies to optimise bowel cleansing in patients at high risk of having poor preparation.
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Hochberg I, Segol O, Shental R, Shimoni P, Eldor R. Antihyperglycemic therapy during colonoscopy preparation: A review and suggestions for practical recommendations. United European Gastroenterol J 2019; 7:735-740. [PMID: 31316777 DOI: 10.1177/2050640619846365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/02/2019] [Indexed: 01/14/2023] Open
Abstract
Patients with diabetes have distinct risks during precolonoscopy bowel preparation, caused by change of diet, change of antihyperglycemic medication regimens and diabetes-related complications and comorbidities. These risks include hypoglycemia, water and electrolyte imbalance, acute renal failure, lactic acidosis, ketoacidosis and low quality of bowel preparation. Here we review the existing literature and present recommendations from a subcommittee of the Israeli National Diabetes Council for primary care physicians and gastroenterologists. The instructions include general suggestions on diet and glucose monitoring and specific recommendations on timing of modification or cessation of each of the antihyperglycemic medication types to ensure patient safety during bowel preparation.
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Affiliation(s)
- Irit Hochberg
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
| | - Ori Segol
- Unit of Gastroenterology, Carmel Medical Center, Haifa, Israel
| | - Rachel Shental
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
| | - Pnina Shimoni
- Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel
| | - Roy Eldor
- Diabetes Unit, Institute for Metabolism, Endocrinology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Randomized Clinical Trial: A Normocaloric Low-Fiber Diet the Day Before Colonoscopy Is the Most Effective Approach to Bowel Preparation in Colorectal Cancer Screening Colonoscopy. Dis Colon Rectum 2019; 62:491-497. [PMID: 30844973 PMCID: PMC6445600 DOI: 10.1097/dcr.0000000000001305] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clinical guidelines recommend either a clear-liquid diet or a low-fiber diet for colonoscopy preparation. Participants in a screening program are usually motivated healthy individuals in which a good tolerability is important to improve adherence to potential surveillance colonoscopies. OBJECTIVE Our aim was to assess whether or not a normocaloric low-fiber diet followed the day before a screening colonoscopy compromises the efficacy of bowel cleansing and may improve the tolerability of bowel preparation. DESIGN This is a randomized, endoscopist-blinded, noninferiority clinical trial. SETTINGS The study was conducted at a tertiary care center. PATIENTS A total of 276 consecutive participants of the Barcelona colorectal cancer screening program were included. INTERVENTION Participants were randomly assigned to a clear-liquid diet or a normocaloric low-fiber diet the day before the colonoscopy. Both groups received 4 L of polyethylene glycol in a split-dose regimen. MAIN OUTCOME MEASURES Primary outcome was the adequate bowel preparation rate measured with the Boston bowel preparation scale. Secondary outcomes included tolerability, fluid-intake perception, hunger, side effects, and acceptability. RESULTS Participants in both groups were similar in baseline characteristics. Adequate bowel preparation was achieved in 89.1% vs 95.7% in clear-liquid diet and low-fiber diet groups, showing not only noninferiority, but also superiority (p = 0.04). Low-fiber diet participants reported less fluid-intake perception (p = 0.04) and less hunger (p = 0.006), with no differences in bloating or nausea. LIMITATIONS The single-center design of the study could limit the external validity of the results. The present findings may not be comparable to other clinical settings. CONCLUSION A normocaloric low-fiber diet the day before a screening colonoscopy achieved better results than a clear-liquid diet in terms of adequate colon preparation. Moreover, it also improved the perception of hunger and excessive fluid intake. Registered at clinicaltrials.gov: NCT02401802. See Video Abstract at http://links.lww.com/DCR/A829.
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Megna B, Weiss J, Ley D, Saha S, Pfau P, Grimes I, Li Z, Caldera F. Clear liquid diet before bowel preparation predicts successful chromoendoscopy in patients with inflammatory bowel disease. Gastrointest Endosc 2019; 89:373-379.e2. [PMID: 30339950 DOI: 10.1016/j.gie.2018.09.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 09/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Chromoendoscopy (CE) has been shown to generate both a superior diagnostic yield and dysplasia detection rate than conventional white-light endoscopy and requires a high-quality bowel preparation. The aim of this study was to identify predictors of the ability to perform CE in patients with inflammatory bowel disease (IBD). METHODS We performed an observational study of patients with IBD undergoing colorectal cancer surveillance examinations with CE. Same-day colonoscopy surveys were used to collect patient and procedural variables. Multivariate logistic regression was used to establish odds ratios of successful completion of CE. RESULTS Eighty-eight patients with IBD were enrolled. We found that patients who did not follow a clear liquid diet before colonoscopy had much lower odds of being able to undergo CE (odds ratio, 0.106; 95% confidence interval, 0.013-0.845; P < .034). Further, we found that previously identified risk factors (older age, history of diabetes mellitus, the timing and split dosing of preparation solution, and procedure time (AM or PM), chronic narcotic use, and history of constipation) for inadequate bowel preparation were not associated with the ability to perform CE. CONCLUSIONS Following a clear liquid diet the entire day before the procedure was highly predictive of the ability to perform CE. However, established risk factors for inadequate bowel preparation did not inhibit the ability to perform CE in our population. Endoscopists performing CE should consider recommending that patients follow a clear liquid diet the entire day before their examination.
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Affiliation(s)
- Bryant Megna
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jennifer Weiss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin, Madison, Wisconsin, USA
| | - Dana Ley
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sumona Saha
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin, Madison, Wisconsin, USA
| | - Patrick Pfau
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin, Madison, Wisconsin, USA
| | - Ian Grimes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin, Madison, Wisconsin, USA
| | - Zhanhai Li
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin, USA
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin, Madison, Wisconsin, USA
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Tariq H, Kamal MU, Sapkota B, ElShikh F, Pirzada UA, Pullela N, Azam S, Zhang A, Baiomi A, Abbas H, Makker J, Balar B, Ihimoyan A, Daniel M, Dev A. Evaluation of the combined effect of factors influencing bowel preparation and adenoma detection rates in patients undergoing colonoscopy. BMJ Open Gastroenterol 2019; 6:e000254. [PMID: 30740233 PMCID: PMC6347943 DOI: 10.1136/bmjgast-2018-000254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 12/18/2022] Open
Abstract
Background Colonoscopy is a commonly used modality for screening and surveillance of colorectal cancer (CRC). Therefore, it is essential to have adequate bowel preparation (prep) for the procedure which depends on type of bowel regimens, diet before colonoscopy and timing of the procedure. Aims The purpose of this study is to analyse the effect of multiple factors on adenoma detection rate (ADR) and prep quality of colonoscopy. This is the also the first study determining outcomes based on various combinations of diet, timing of the procedure and bowel prep regimens. Methods This is a retrospective single-centre observational study. Data about diet before procedure, bowel prepprep regimen and timing of the procedure was collected for patients coming for screening colonoscopy. Results Patients with split prep had higher good prep rates (73.8% vs 56.2%) and higher ADRs (34.2 % vs 29.9%) as compared with non-split prep. The good prep quality (65.8% vs 62.1%) and ADRs (31.9% vs 31.5%) were comparable in patients who received clear liquid diet as compared with low residue diet. The good results of bowel prep were obtained with split prep with either clear liquids or low residue diet irrespective of the timing of procedure. The poor prep was noticed in patients who underwent procedure in afternoon, with a low restrictive diet and non-split bowel regimen. Conclusions The current study adds to our knowledge about the combined effect of multiple variables affecting the bowel prep quality and ADR. It is imperative to opt for the best combination required for colonoscopy, as this will influence the effectiveness of colonoscopies regarding timely cancer detection and prevention.
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Affiliation(s)
- Hassan Tariq
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Muhammad Umar Kamal
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Binita Sapkota
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Fady ElShikh
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Usman Ali Pirzada
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Nanda Pullela
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Sara Azam
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Aiyi Zhang
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Ahmed Baiomi
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Hafsa Abbas
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Jasbir Makker
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Bhavna Balar
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Ariyo Ihimoyan
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Myrta Daniel
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Anil Dev
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
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Results of a Community-based, Randomized Study Comparing a Clear Liquid Diet With a Low-residue Diet Using a Magnesium Citrate Preparation for Screening and Surveillance Colonoscopies. J Clin Gastroenterol 2019; 53:34-39. [PMID: 29112048 DOI: 10.1097/mcg.0000000000000959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Current bowel preparations for colonoscopy include a clear liquid diet (CLD) along with consumption of a laxative. This dietary restriction along with large volume bowel preparations are barriers to compliance and willingness among patients in scheduling screening examinations. The aim of our study was to compare the efficacy and tolerability of a low-volume split dose magnesium citrate bowel preparation in patients on a low-residue diet (LRD) with those on a CLD. METHODS In this single center, single blinded, randomized controlled trial, patients scheduled for outpatient colonoscopies were assigned to either a CLD or a LRD 1 day before the examination. Both groups received a split dose magnesium citrate preparation. The quality of the preparation was rated using the Boston Bowel Preparation Scale (BBPS). Patient satisfaction and side effects were evaluated using a questionnaire. RESULTS We were unable to detect a significant difference in the BBPS scores between the LRD and CLD groups (P=0.581). A significantly higher percentage of patients in the LRD group rated the diet as easy compared with the CLD group (P<0.001). Satisfaction scores were significantly higher in the LRD group, compared with the CLD group (P<0.001). The side effect profiles of both arms were similar. CONCLUSIONS There was no significant difference between LRD and CLD in patients using a magnesium citrate bowel preparation for screening and surveillance colonoscopies. Patient satisfaction scores were higher with a LRD compared with a CLD. We believe the LRD should be the recommended diet in patients using a standard bowel preparation for screening and surveillance colonoscopy.
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Spada C, Cannizzaro R, Bianco MA, Conigliaro R, Di Giulio E, Hassan C, Marmo R, Occhipinti P, Radaelli F, Repici A, Ricci E, Costamagna G. Preparation for colonoscopy: Recommendations by an expert panel in Italy. Dig Liver Dis 2018; 50:1124-1132. [PMID: 30172650 DOI: 10.1016/j.dld.2018.07.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite several guidelines on bowel preparation being available, their applicability in Italy is poorly investigated. AIMS (1) To create expert-based recommendations for the Italian setting based on available international guidelines on bowel preparation for colonoscopy; (2) to assess consensus across the Italian endoscopy community. METHODS The study was conducted in 2 phases: (a) statements formulation, (b) assessment of consensus. For the first phase, 6 topics related to bowel preparation were identified: (1) efficacy/tolerability; (2) timing; (3) assessment of quality of bowel preparation; (4) factors associated with inadequate preparation; (5) patient education and (6) impact of organisational factors. For each topic, statements were produced and voted by a panel of experts. For consensus assessment, the invited participants were asked to rate the statements. The statement achieved a good level of agreement when at least 70% of voters agreed with it. RESULTS 25 statements were agreed in the first phase. Agreement was not achieved by the endoscopy community for 7 statements, mainly concerning practical aspects (i.e. strategies for management of patients with inadequate preparation, organisational factors). CONCLUSION A clinically relevant consensus was achieved on the main topics of bowel preparation, such as the choice of laxative and the time of administration, and it may help to homogenize the colonoscopy practice in Italy. Nevertheless, there are a few country-specific preparation-related issues that need to be addressed.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit, A. Gemlli IRCCS University Hospital, Rome, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy.
| | - Renato Cannizzaro
- Department of Gastroenterology, Centro di Riferimento Oncologico, Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | | | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy
| | - Emilio Di Giulio
- Digestive Endoscopy Unit, "La Sapienza" University, Ospedale S. Andrea, Roma, Italy
| | - Cesare Hassan
- Department of Gastroenteology, Ospedale Nuova Regina Margherita, Roma, Italy
| | - Riccardo Marmo
- Gastroenterology and Digestive Endoscopy Unit, Polla Hospital, Salerno, Italy
| | - Pietro Occhipinti
- Gastroenterology and Digestive Endoscopy Unit, Ospedale SS Trinità, Borgomanero, Italy
| | - Franco Radaelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Valduce, Como, Italy
| | - Alessandro Repici
- Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Milano, Italy
| | - Enrico Ricci
- Gastroenterology and Digestive Endoscopy Unit, Ospedale G.B. Morgagni, Forlì, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, A. Gemlli IRCCS University Hospital, Rome, Italy; IHU, USIAS Strasbourg University, Strasbourg, France
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Avalos DJ, Castro FJ, Zuckerman MJ, Keihanian T, Berry AC, Nutter B, Sussman DA. Bowel Preparations Administered the Morning of Colonoscopy Provide Similar Efficacy to a Split Dose Regimen: A Meta Analysis. J Clin Gastroenterol 2018; 52:859-868. [PMID: 28885304 DOI: 10.1097/mcg.0000000000000866] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Comparative efficacy of same-day bowel preparations for colonoscopy remains unclear. AIMS A meta-analysis of randomized controlled trials comparing the efficacy of same-day versus split dose bowel preparations for colonoscopy. METHODS A systematic search was conducted in MEDLINE, clinicaltrials.gov, Cochrane Registry, EMBASE, SCOPUS, Web of Science and CINAHL. Studies were gathered using keywords: "morning preparation", "morning bowel preparation", "same day bowel preparation", and "colonoscopy." Pooled estimates of bowel preparation quality were analyzed among studies with categorical and continuous outcomes according to relative risk (RR) or mean difference (MD). A random effects model was chosen a priori for all analyses. RESULTS A total of 1216 studies were retrieved with 15 trials meeting inclusion criteria. The categorical outcome of high quality bowel preparation for any same-day bowel preparation versus any split preparation was no different with a RR 0.95 [0.90;1.00] (P=0.62). Adenoma detection rate (ADR) was not different between groups, RR 0.97 [0.79;1.20] (P=0.81). Willingness to repeat and tolerability did not differ (RR 1.14 [0.96,1.36] (P=0.14) and RR 1.00 [0.96;1.04] (P=0.98), respectively. Adverse events were similar except for bloating, which was less frequent among the same-day preparation group, RR 0.68 [0.40;0.94] (P=0.02). CONCLUSION No clinically significant differences were noted among recipients of same day or split dose regimens. Adenoma detection rate, willingness to repeat and tolerability were similar, but bloating and interference with sleep favored the same-day preparations. Given lack of clinical differences, patient preference should dictate timing of colonoscopy preparation.
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Affiliation(s)
- Danny J Avalos
- Texas Tech University Health Sciences Center, Division of Gastroenterology, El Paso, TX
| | | | - Marc J Zuckerman
- Texas Tech University Health Sciences Center, Division of Gastroenterology, El Paso, TX
| | | | - Andrew C Berry
- Department of Internal Medicine, University of South Alabama, Mobile, AL
| | - Benjamin Nutter
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH
| | - Daniel A Sussman
- Gastroenterology, University of Miami/Jackson Memorial Hospital, Miami, FL
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Nam SJ, Kim YJ, Keum B, Lee JM, Kim SH, Choi HS, Kim ES, Seo YS, Jeen YT, Lee HS, Chun HJ, Um SH, Kim CD. Impact of diet restriction on bowel preparation for colonoscopy. Medicine (Baltimore) 2018; 97:e12645. [PMID: 30313052 PMCID: PMC6203512 DOI: 10.1097/md.0000000000012645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Diet restriction is one of the difficult parts of bowel preparation for colonoscopy, and many patients do not follow instructions properly. Few studies have evaluated the impact of dietary restriction in real clinical setting. The aim of this study was to study the effect of diet control on bowel preparation with detailed investigation of unacceptable food list in order to reveal what kind of foods are most problematic in clinical practice.Prospective observational study was carried out at a university-affiliated hospital. Around 4 L polyethylene glycol solution was used for bowel preparation on the day of colonoscopy. Patients were allowed to have regular diet until lunch the day before colonoscopy and educated to control diet from 3 days before colonoscopy with information regarding an unacceptable foods list. Factors associated with inadequate bowel preparation were analyzed using univariate statistics and multivariate logistic regression analysis.Of the 245 patients included in the study, 68 patients (27.8%) followed the diet instructions. Fiber-rich vegetables were the most commonly taken unacceptable foods (N = 143, 58.4%). Inadequate bowel preparation (fair and poor by Aronchick scale) was 47.3%. In multivariate analysis, diabetes [odds ratio (OR) 2.878, 95% confidence interval (CI) 1.242-6.671], preparation to colonoscopy interval (OR 1.003, 95% CI 1.000-1.005) and consumption of foods disturbing bowel preparation (OR 2.142, 95% CI 1.108-4.140) were independent predictors of inadequate bowel preparation.We could identify substantially low compliance to diet instructions in real clinical practice. Consumption of any foods disturbing bowel preparation was significant factor predicting inadequate bowel preparation, even though we could not select specific food list compromising preparation significantly. Favorable bowel preparation was achieved in the subgroup compliant to diet restriction, suggesting that regular diet avoiding specific kinds of foods can be possible option for diet restriction before colonoscopy.
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Affiliation(s)
- Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon
| | - Young Jin Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Wang X, Zhu XQ. Research progress on patient comfort during bowel preparation. Shijie Huaren Xiaohua Zazhi 2018; 26:1015-1021. [DOI: 10.11569/wcjd.v26.i17.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bowel preparation is one of the key and necessary steps for preoperative preparations of multiple operations such as electronic colonoscopy, capsule endoscopy, barium X-ray, colorectal surgery, gynecology surgery, and urology surgery. Although better methods for bowel preparation have been explored continuously, patient intolerance still exists during the current bowel preparation process. Adverse reactions such as nausea and vomiting often occur, leading to poor comfort experience and affecting the patient's compliance and bowel preparation results. This article reviews the factors influencing patient comfort during bowel preparation and the corresponding interventions.
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Affiliation(s)
- Xia Wang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiu-Qin Zhu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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