Korean J Gastroenterol.  2016 Aug;68(2):70-76. 10.4166/kjg.2016.68.2.70.

Formulation and Management of Poor Bowel Preparation: A Survey Study

• Seong JH
• Yoo JS
• Lee KJ
• Park HJ
• Kim HM
• Kim JW
• Kim HS

• KMID: 2350083
• DOI: http://doi.org/10.4166/kjg.2016.68.2.70

Abstract

BACKGROUND/AIMS
There are no established guidelines for bowel preparation formulation for bowel cleansing, nor is there an optimal method of dealing with inadequate bowel cleansing. This study investigated bowel preparation formulation preferences and responses to bowel preparation situations using surveys.
METHODS
The study surveyed 221 Korean lower gastrointestinal endoscopists from January to March 2015 and assessed their responses.
RESULTS
The analysis indicated that 2-L polyethylene glycol (PEG) plus ascorbic acid (Asc) was the preferred method (76.5%) and most responders expressed satisfaction with the formulation in both potency and safety. To address poor bowel preparation on the day of colonoscopy, the majority of physicians chose to order ingestion of additional preparations and proceed with the colonoscopy as scheduled (56.6%). In addition, concerns about renal safety and electrolyte stability were raised regarding oral sodium phosphate.
CONCLUSIONS
This study found that 2-L PEG+Asc was preferred for potency and safety, and that Korean endoscopists preferred to proceed with colonoscopy in poor bowel preparation situations rather than choose an alternate diagnostic modality.

Keyword

Colonoscopy; Cathartics

MeSH Terms

Ascorbic Acid
Cathartics
Colonoscopy
Eating
Methods
Polyethylene Glycols
Sodium
Ascorbic Acid
Cathartics
Polyethylene Glycols
Sodium

Reference

References

1. Rex DK, Johnson DA, Lieberman DA, Burt RW, Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. American College of Gastroenterology. Am J Gastroenterol. 2000; 95:868–877.

2. Kim SE, Hong SP, Kim HS, et al. A Korean national survey for colorectal cancer screening and polyp diagnosis methods using web-based survey. Korean J Gastroenterol. 2012; 60:26–35.

3. American Society of Colon and Rectal Surgeons (ASCRS). American Society for Gastrointestinal Endoscopy (ASGE). Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). A consensus document on bowel preparation before colonoscopy: prepared by a Task Force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc. 2006; 20:1161.

4. Adler M, Quenon M, Even-Adin D, et al. Whole gut lavage for colonoscopy–a comparison between two solutions. Gastrointest Endosc. 1984; 30:65–67.

5. Ell C, Fischbach W, Keller R, et al. A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing solutions for colonoscopy (HSG-01*). Endoscopy. 2003; 35:300–304.

6. Park S, Lim YJ. Adjuncts to colonic cleansing before colonoscopy. World J Gastroenterol. 2014; 20:2735–2740.

7. Moon CM, Park DI, Choe YG, et al. Randomized trial of 2-L polyethylene glycol ＋ ascorbic acid versus 4-L polyethylene glycol as bowel cleansing for colonoscopy in an optimal setting. J Gastroenterol Hepatol. 2014; 29:1223–1228.

8. Hookey LC, Depew WT, Vanner SJ. A prospective randomized trial comparing low-dose oral sodium phosphate plus stimulant laxatives with large volume polyethylene glycol solution for colon cleansing. Am J Gastroenterol. 2004; 99:2217–2222.

9. Hookey LC, Vanner S. Recognizing the clinical contraindications to the use of oral sodium phosphate for colon cleansing: a case study. Can J Gastroenterol. 2004; 18:455–458.

10. Rahman A, Vanner SJ, Baranchuk A, Hookey LC. Serial monitoring of the physiological effects of the standard Pico-SalaxⓇregimen for colon cleansing in healthy volunteers. Can J Gastroenterol. 2012; 26:424–428.

11. Jung YS, Lee CK, Kim HJ, Eun CS, Han DS, Park DI. Randomized controlled trial of sodium phosphate tablets vs polyethylene glycol solution for colonoscopy bowel cleansing. World J Gastroenterol. 2014; 20:15845–15851.

12. Ball JE, Osbourne J, Jowett S, Pellen M, Welfare MR. Quality improvement programme to achieve acceptable colonoscopy completion rates: prospective before and after study. BMJ. 2004; 329:665–667.

13. Soweid AM, Kobeissy AA, Jamali FR, et al. A randomized single-blind trial of standard diet versus fiber-free diet with polyethylene glycol electrolyte solution for colonoscopy preparation. Endoscopy. 2010; 42:633–638.

14. Bang KB, Jeong EH, Jeong WS, et al. Efficacy of bisacodyl given as part of a polyethylene glycol-based bowel preparation prior to colonoscopy in hospitalized patients: a prospective ramdomized trial. Korean J Gastroenterol. 2014; 64:268–277.

15. Horiuchi A, Nakayama Y, Kajiyama M, et al. Colonoscopic enema as rescue for inadequate bowel preparation before colonoscopy: a prospective, observational study. Colorectal Dis. 2012; 14:e735–e739.

16. Singh K, Narula AK, Thukral CL, Singh NR, Singh A, Kaur H. Role of CT colonography in colonic lesions and its correlation with conventional colonoscopic findings. J Clin Diagn Res. 2015; 9:TC14–TC18.

17. Park JB, Lee YK, Yang CH. The evolution of bowel preparation and new developments. Korean J Gastroenterol. 2014; 63:268–275.

18. Lee YH, Jeong SY, Kim YS, et al. Randomized controlled trial of sodium phosphate tablets versus 2 L polyethylene glycol solution for bowel cleansing prior to colonoscopy. Korean J Gastroenterol. 2015; 65:27–34.