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Tamai N, Sumiyama K. Optimal bowel preparation for colonoscopy. Dig Endosc 2024. [PMID: 39229776 DOI: 10.1111/den.14914] [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: 01/29/2024] [Accepted: 08/07/2024] [Indexed: 09/05/2024]
Abstract
There is robust evidence to indicate a strong correlation between the bowel preparation status and adenoma detection rate (ADR), which directly impacts the incidence and mortality rate of postcolonoscopy colorectal cancer. Therefore, improving bowel preparation has been of increasing interest. In Japan, commercially available bowel preparation agents include polyethylene glycol, oral sodium sulfate, sodium picosulfate-magnesium citrate, magnesium citrate, and oral sodium phosphate; each has its own strengths and limitations. The timing of administration can also influence the efficacy of bowel preparation and patient tolerability. Furthermore, meta-analyses have suggested predictive factors for inadequate bowel preparation. A detailed understanding of these factors could contribute to reducing the need for repeat colonoscopy within 1 year, as recommended for patients with inadequate bowel preparation. Recent advancements, such as oral sulfate tablets, present promising alternatives with higher patient satisfaction and ADRs than traditional methods. Achieving optimal bowel preparation requires enhanced instructions, individualized regimens, and a comprehensive understanding of patient backgrounds and the characteristics of various bowel preparation agents. This article provides a concise overview of the current status and advancements in bowel preparation for enhancing the quality and safety of colonoscopy.
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Affiliation(s)
- Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
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Liu X, Yu W, Liu J, Liu Q. Oral sulfate solution versus polyethylene glycol for bowel preparation before colonoscopy, meta-analysis and trial sequential analysis of randomized clinical trials. Tech Coloproctol 2024; 28:99. [PMID: 39138737 DOI: 10.1007/s10151-024-02981-9] [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: 03/20/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND This study aimed to compare oral sulfate solution (OSS) with polyethylene glycol (PEG) for bowel preparation before colonoscopy. METHODS A literature search was performed on PubMed, Ovid, and Cochrane Databases for randomized clinical trials (RCT) comparing OSS with PEG for bowel preparation before colonoscopy. The last search was performed on 22 August 2023. The primary outcome was the quality of bowel preparation. The outcomes were compared by meta-analysis and trial sequential analysis (TSA). RESULTS A total of 14 RCTs with 4526 patients were included. OSS was comparable with PEG regarding adequate bowel preparation [P = 0.16, odds ratio (OR) = 1.19, 95% confidence interval (CI) [0.93, 1.51], I2 = 0%]. However, OSS showed obvious priority in excellent bowel preparation (P < 0.001, OR = 1.62, 95% CI [1.27, 2.05], I2 = 0%) and total Boston bowel preparation scale (BBPS) [P = 0.02, weighted mean difference (WMD) = 0.27, 95% CI [0.05, 0.50], I2 = 84%]. Additionally, the detection rate of polyps (P = 0.001, OR = 1.44, 95% CI [1.15, 1.80], I2 = 0%) and adenoma (P = 0.007, OR = 1.22, 95% CI [1.06, 1.42], I2 = 0%) was significantly higher in the OSS group. The two groups showed comparable incidence of adverse events except for a higher incidence of dizziness (P = 0.02, OR = 1.74, 95% CI [1.08, 2.83], I2 = 11%) was indicated in the OSS group. Moreover, OSS was associated with a higher satisfaction score (P = 0.02, WMD = 0.62, 95% CI [0.09, 1.15], I2 = 70%). In the TSA, the cumulative Z-curve crossed both the conventional boundary and trial sequential monitoring boundary and the required information size has been reached for excellent bowel preparation and total BBPS. CONCLUSION The current data demonstrated that OSS was associated with better quality of bowel preparation. More clinical trials are still needed to confirm other outcomes.
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Affiliation(s)
- X Liu
- Department of General Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiu Jiang No.1 People's Hospital, No. 48, Taling South Road, Jiujiang City, 332000, Jiangxi Province, China
| | - W Yu
- Department of General Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiu Jiang No.1 People's Hospital, No. 48, Taling South Road, Jiujiang City, 332000, Jiangxi Province, China
| | - J Liu
- Department of General Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiu Jiang No.1 People's Hospital, No. 48, Taling South Road, Jiujiang City, 332000, Jiangxi Province, China
| | - Q Liu
- Department of General Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiu Jiang No.1 People's Hospital, No. 48, Taling South Road, Jiujiang City, 332000, Jiangxi Province, China.
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Chen HY, Tu MH, Chen MY. Effectiveness of a Mobile Health Application for Educating Outpatients about Bowel Preparation. Healthcare (Basel) 2024; 12:1374. [PMID: 39057517 PMCID: PMC11275862 DOI: 10.3390/healthcare12141374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Colonoscopy is an essential method for diagnosing and treating colorectal cancer, relying on effective bowel preparation to thoroughly examine the large intestinal mucosa. Traditional education involves printed instructions and verbal explanations but does not guarantee clear patient understanding. Poor bowel preparation can obscure mucosal visibility, delaying cancer diagnosis and treatment. A mobile medical model using Android devices for bowel preparation education was tested in a single-blind, randomized trial. This trial enrolled outpatients undergoing colonoscopy at the Endoscopy Center for Diagnostic and Treatment between 27 October 2021 and 31 December 2022. This study introduced the ColonClean app alongside traditional methods. After examination, endoscopists rated the preparation quality using the Aronchick scale. A data analysis was conducted using SPSS 25.0 to determine if there was a significant improvement in bowel preparation quality between the control group (traditional method) and the experimental group (traditional method plus the ColonClean app). Forty patients were recruited in each group. In the experimental group, all ratings were "fair", with 75% receiving an "excellent" or "good" rating, showing statistical significance (p = 0.016). The ColonClean app improves bowel preparation quality more effectively than traditional care instructions.
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Affiliation(s)
- Hui-Yu Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (H.-Y.C.); (M.-Y.C.)
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Ming-Hsiang Tu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (H.-Y.C.); (M.-Y.C.)
| | - Miao-Yen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (H.-Y.C.); (M.-Y.C.)
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Pan P, Zhao S, Wang S, Song Y, Gu L, Chen Y, Zhao J, Lu L, Li X, Xu H, Liu G, Li Y, Xu L, Wang J, Li Z, Bai Y. Comparison of the efficacy and safety of an oral sulfate solution and 3-L polyethylene glycol on bowel preparation before colonoscopy: a phase III multicenter randomized controlled trial. Gastrointest Endosc 2023; 98:977-986.e14. [PMID: 37422241 DOI: 10.1016/j.gie.2023.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/09/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND AND AIMS Adequate bowel preparation is crucial for clear mucosal visualization during colonoscopy. We aimed to comprehensively compare oral sulfate solution (OSS) and 3-L split-dose polyethylene glycol (PEG) for bowel preparation before colonoscopy. METHODS This randomized, active-controlled, noninferiority study was performed in 10 medical centers. Eligible subjects were enrolled to receive OSS or 3-L PEG in a split-dose regimen. The quality of bowel preparation, adverse reactions, and acceptability were evaluated. The quality of bowel preparation was evaluated using the Boston Bowel Preparation Scale. Safety was evaluated by adverse reactions. The study population was divided into the full analysis set (FAS), the safety set, the modified FAS (mFAS), and the per-protocol set (PPS). RESULTS Three hundred forty-eight potentially eligible subjects were enrolled. Three hundred forty-four subjects were included in the FAS and safety set, 340 subjects were included in the mFAS, and 328 subjects were included in the PPS. Adequate bowel preparation of the OSS was not inferior to 3-L PEG in the mFAS (98.22% vs 97.66%) and the PPS (98.17% vs 98.78%). There was no significant difference in acceptability between the 2 groups (94.74% vs 94.80%, P = .9798). Overall adverse reactions were similar (50.88% vs 44.51%, P = .2370) between the 2 groups. CONCLUSIONS The split-dose OSS regimen was not inferior to the split-dose 3-L PEG regimen for the quality of bowel preparation in a Chinese adult population. The safety and acceptability of the 2 groups were similar. (Clinical trial registration number: NCT05465889.).
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Affiliation(s)
- Peng Pan
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Shengbing Zhao
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Shuling Wang
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Yihang Song
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Lun Gu
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Youxiang Chen
- Department of Gastroenterology, the First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Jiangrong Zhao
- Department of Gastroenterology, Shanghai Integrative Medicine Hospital, Shanghai, China
| | - Lungen Lu
- Department of Gastroenterology, Shanghai First People's Hospital, Shanghai, China
| | - Xiuling Li
- Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Hongzhi Xu
- Department of Gastroenterology, Zhongshan Hospital of Xiamen University, Xiamen, China
| | - Gaifang Liu
- Department of Gastroenterology, Hebei Provincial People's Hospital, Shijiazhuang, China
| | - Yanqing Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Le Xu
- Department of Gastroenterology, Beijing Hospital, Beijing, China
| | - Jiangbin Wang
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, China
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Yoshida N, Inagaki Y, Hasegawa D, Kobayashi R, Tomita Y, Hashimoto H, Hirose R, Dohi O, Inoue K, Morimoto Y, Inada Y, Murakami T, Itoh Y. The Efficacy of 480 ml Oral Sodium Sulfate for Improving Insufficient Bowel Preparation of Colonoscopy with High-Concentrated Polyethylene Glycol. Gastroenterol Res Pract 2023; 2023:6359165. [PMID: 37808965 PMCID: PMC10560111 DOI: 10.1155/2023/6359165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives Oral sulfate solution (OSS) is used for bowel preparation (BP) during colonoscopy. The way of taking this agent can be used a same-day regimen (only on the day of colonoscopy) and split regimen (the day before and on the day of colonoscopy) for receiving it. In this study, we analyzed the efficacy of a same-day regimen of 480 ml OSS for insufficient bowel preparation (BP) with high-concentrated polyethylene glycol (H-PEG). Materials and Methods This multicenter retrospective study was conducted from December 2021 to December 2022 at three related institutions on patients aged ≥ 20 years with a fair or poor Aronchick score of BP with 1 l H-PEG in previous colonoscopy. All patients received a low-residual diet and 10 ml of 0.75% picosulfate sodium a day before the colonoscopy and 480 ml of OSS and ≥1 l of water 3 hours before the colonoscopy. We analyzed the rate of improvement with OSS compared to H-PEG and other efficacies, and adverse events (AE). Results We evaluated 125 cases (77 males) with an average age of 72.1 ± 8.8 years. The completion rate of 480 ml of OSS was 97.6% (122/125). The improvement rate of BP showing good or excellent score with OSS was 70.4% (88/125). Compared OSS with previous H-PEG, the insertion time (min) was 7.0 ± 4.8 vs. 8.1 ± 6.0 (p = 0.01), and the adenoma detection rates were 67.2% vs. 63.2% (p = 0.05). The cleansing time (min) was 131 ± 46 vs. 165 ± 53 (p < 0.01). The rate of AE with OSS was 10.4% (13/125). There were no significant differences about AE in age and gender. The tolerance of OSS compared with H-PEG (good/similar/bad) was 72.0%/24.8%/3.2% (amounts), 26.4%/39.2%/34.4% (taste), and 76.8%/10.4%/12.8% (overall preference), respectively. Conclusions The same-day regimen of 480 ml OSS effectively improved the insufficient BP of 1 l H-PEG.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | | | - Daisuke Hasegawa
- Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yuri Tomita
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yasutaka Morimoto
- Department of Gastroenterology, Kyoto Saiseikai Hospital, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Labenz J, Borkenstein DP, Heil FJ, Madisch A, Tappe U, Schmidt H, Terjung B, Klymiuk I, Horvath A, Gross M, Stadlbauer V. Application of a multispecies probiotic reduces gastro-intestinal discomfort and induces microbial changes after colonoscopy. Front Oncol 2023; 12:1078315. [PMID: 36698396 PMCID: PMC9870247 DOI: 10.3389/fonc.2022.1078315] [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: 10/24/2022] [Accepted: 12/02/2022] [Indexed: 01/11/2023] Open
Abstract
Even after decades of research and pharmaceutical development, cancer is still one of the most common causes of death in the western population and the management of cancer will remain a major challenge of medical research. One of the most common types of cancer is colorectal cancer (CRC). Prevention by detection of early-stage precursors is the most reliable method to prevent CRC development. In dependence of age, familial predisposition, and other risk factors the preventative routine screening for CRC by colonoscopy should be performed at least twice in intervals of about ten years. Although colonoscopy is a life-saving clinical examination reducing both incidence and mortality of CRC significantly, it has still a bad reputation in the population as an uncomfortable procedure with unpleasant side effects lasting sometimes over days to weeks. These effects are most likely caused by the bowel preparation before colonoscopy, which is crucial for a successful colonoscopy with high quality. Beside pain, bleeding and other rare but severe complications of colonoscopy, cleaning of the intestinal mucosa alters the gut microbiome significantly and consistently. Abdominal pain, cramps, diarrhea, nausea, bloating, and constipation are common adverse events which can continue to affect patients for days or even weeks after the procedure. In this multicenter, placebo controlled, double blind clinical trial, we investigated the effect of an intervention with a multispecies probiotic formulation for 30 days on the adverse events due to bowel preparation. We show that the treatment of participants with the multispecies probiotic formulation decreases the number of days with constipation significantly, and reduced pain, bloating, diarrhea, and general discomfort. 16S based amplicon analyses reveal recovery of administered probiotic strains from stool samples and differences in alpha diversity dynamics with higher variability in the probiotic group compared to the placebo group. In conclusion, the probiotic ameliorates the side effects after colonoscopy and might be an important supplement to increase acceptance of this life-saving preventative examination. Further, we present here for the first time that probiotic intervention of only 30 days affects alpha diversity parameters in stool samples.
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Affiliation(s)
- Joachim Labenz
- Department of Internal Medicine, Diakonie Klinikum Jung-Stilling, Siegen, Germany
| | | | | | - Ahmed Madisch
- Department of Internal Medicine I, Hospital Clinic Siloah, Hannover, Germany
- Centrum Gastroenterologie Bethanien, Agaplesion Krankenhaus Bethanien, Frankfurt, Germany
| | - Ulrich Tappe
- Gastropraxis an der St. Barbara Klinik, Hamm, Germany
| | - Harald Schmidt
- Praxis für Innere Medizin und Gastroenterologie Dr. H. Schmidt, Berlin, Germany
| | | | - Ingeborg Klymiuk
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Angela Horvath
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Area 3 Microbiome Modulation for Precision Medicine, Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Manfred Gross
- Department of Internal medicine, Internistisches Klinikum München Süd, Munich, Germany
| | - Vanessa Stadlbauer
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Area 3 Microbiome Modulation for Precision Medicine, Center for Biomarker Research in Medicine (CBmed), Graz, Austria
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Tamai N, Adachi S, Sumiyama K. Bowel preparation for improving the quality of colonoscopy. Dig Endosc 2022; 34:1134-1135. [PMID: 35652389 DOI: 10.1111/den.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Sei Adachi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
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