The lower the volume of a cleansing product the higher its osmolarity and thus the risk of determining electrolyte imbalances in predisposed patients

10.1055/a-1478-3361Because colorectal cancer (CRC) represents a significant cause of mortality worldwide and incidence is rising in younger people, particular importance is given to effective screening programs, including noninvasive and invasive modalities [1]. In particular, colonoscopy has a central role in detecting early-stage CRC and identifying and resecting precancerous lesions. A quality examination requires adequate bowel preparation, considering that poor colon cleansing negatively influences quality indicators for colonoscopy, such as adenoma detection rate and cecal intubation. The theme of ideal bowel preparation is still controversial, because it should meet criteria of tolerability and efficacy, but safety also is a concern, particularly in fragile patients [2].

Publication History

Article published online:
16 July 2021

• References

• 1 Ladabaum U, Dominitz JA, Kahi C. et al. Strategies for colorectal cancer screening. Gastroenterology 2020; 158: 418-432
• 2 Jang JY, Chun HJ. Bowel preparations as quality indicators for colonoscopy. World J Gastroenterol 2014; 20: 2746-2750
• 3 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
• 4 Maida M, Macaluso FS, Sferrazza S. et al. Effectiveness and safety of NER1006 versus standard bowel preparations: A meta-analysis of randomized phase-3 clinical trials. Dig Liver Dis 2020; 52: 833-839
• 5 Marín Gabriel JC, Rodríguez Muñoz S, de la Cruz Bértolo J. et al. Electrolytic disturbances and colonoscopy: bowel lavage solutions, age and procedure. Rev Esp Enferm Dig 2003; 95: 863-875
• 6 Reumkens A, Masclee AA, Winkens B. et al. Prevalence of hypokalemia before and after bowel preparation for colonoscopy in high-risk patients. Gastrointest Endosc 2017; 86: 673-679
• 7 Brunelli SM. Association between oral sodium phosphate bowel preparations and kidney injury: a systematic review and meta-analysis. J Kidney Dis 2009; 53: 448-456
• 8 Hookey LC, Depew WT, Vanner S. The safety profile of oral sodium phosphate for colonic cleansing before colonoscopy in adults. Gastrointest Endosc 2002; 56: 895-902
• 9 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy 2019; 51: 775-794
• 10 Ho JM, Juurlink DN, Cavalcanti RB. Hypokalemia following polyethylene glycol-based bowel preparation for colonoscopy in older hospitalized patients with significant comorbidities. Ann Pharmacother 2010; 44: 466-470
• 11 Lee KJ, Park HJ, Kim HS. et al. Electrolyte changes after bowel preparation for colonoscopy: A randomized controlled multicenter trial. World J Gastroenterol 2015; 21: 3041-3048
• 12 Bisschops R, Manning J, Clayton LB. et al. Colon cleansing efficacy and safety with 1 L NER1006 versus 2 L polyethylene glycol + ascorbate: a randomized phase 3 trial. Endoscopy 2019; 51: 60-72
• 13 Rex DK, McGowan J, Cleveland MV. et al. A randomized, controlled trial of oral sulfate solution plus polyethylene glycol as a bowel preparation for colonoscopy. Gastrointest Endosc 2014; 80: 482-491
• 14 Mathus-Vliegen EM, van der Vliet K. Safety, patient's tolerance, and efficacy of a 2-liter vitamin C-enriched macrogol bowel preparation: a randomized, endoscopist-blinded prospective comparison with a 4-liter macrogol solution. Dis Colon Rectum 2013; 56: 1002-1012