Subscribe to RSS
DOI: 10.1055/s-2007-963632
© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York
Positionspapier der Sektion Endoskopie der DGVS zur Darmreinigung vor Koloskopie
Publication History
Publication Date:
19 November 2007 (online)

Einleitung
Nach Angaben des Statistischen Bundesamtes verstarben im Jahr 2005 in der Bundesrepublik Deutschland 27 223 Menschen an „bösartigen Neubildungen des Dickdarms”. Das kolorektale Karzinom ist damit bei Mann und Frau die zweithäufigste tumorbedingte Todesursache. Die Koloskopie ist die Methode der Wahl zur Untersuchung des Kolons und es ist die effektivste Vorsorgeuntersuchung. Die Reduktion der Inzidenz und der Mortalität des kolorektalen Karzinoms ist sowohl für den Haemoccult-Test und inzwischen auch für die Koloskopie bei einem Polypenkollektiv (National Polyp Study) belegt [1]. Die Rate der bei der Vorsorgekoloskopie gefundenen krebsrelevanten Polypen liegt bei ca. 6 %, die der neu entdeckten Karzinome bei 1 %. Die Zahl der notwendigen Koloskopien zur Entdeckung eines fortgeschrittenen Polypen liegt in Abhängigkeit vom Geschlecht und Alter zwischen 36 und 10, sie steigt mit zunehmenden Alter und männlichem Geschlecht [2]. Die Vorsorgekoloskopie sollte nach den derzeit gültigen deutschen Leitlinien spätestens im Alter von 55 Jahren durchgeführt werden [3].
Die Detektionsrate von Adenomen und kolorektalen Karzinomen hängt entscheidend von der Qualität der Darmvorbereitung ab [4] [5] [6]. Nach einer optimalen Darmreinigung sollten nur wenig Restflüssigkeit und keine Reststuhlmengen im Kolon zurückbleiben. Eine unzureichende Darmreinigung reduziert die Beurteilbarkeit der Darmmukosa erheblich, führt zu einer verlängerten Untersuchungszeit, verbunden mit Unannehmlichkeiten für den Patienten, und ggf. auch zu einem Abbruch der Untersuchung, der eine Wiederholungsuntersuchung erforderlich macht [7]. Eine schlechte Darmvorbereitung betrifft insbesondere das Zökum und Colon ascendens. Studien der letzten Jahre haben gezeigt, dass gerade im Zökum und C. ascendens gehäuft flache Adenome zu finden sind [8] [9] [10], deren Detektion eine optimale Reinigung dieses Darmsabschnittes voraussetzt.
Ein wichtiger Faktor für eine gute Darmvorbereitung stellt die Compliance der Patienten dar, die in der Regel einfach zu handhabende kurze Vorbereitungsregime mit akzeptablem Geschmack und wenig Trinkvolumen bevorzugen.
Das vorliegende Papier soll nach Vorstellung und Diskussion der aktuellen Datenlage die Position der Sektion Endoskopie der DGVS zur Koloskopievorbereitung beschreiben.
Literatur
- 1
Zauber A G, Winawer S J, O’Brien M J. et al .
Significant Long Term Reduction in Colorectal Cancer Mortality with Colonoscopic Polypectomy:
Findings of the National Polyp Study.
DDW.
2007;
Abstract ID 268
Reference Ris Wihthout Link
- 2
Regula J, Rupinski M, Kraszewska E. et al .
Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia.
N Engl J Med.
2006;
355
1863-1872
Reference Ris Wihthout Link
- 3
Schmiegel W, Adler G, Fruhmorgen P. et al .
Colorectal carcinoma: prevention and early detection in an asymptomatic population
- prevention in patients at risk - endoscopic diagnosis, therapy and after-care of
polyps and carcinomas. German Society of Digestive and Metabolic Diseases/Study Group
for Gastrointestinal Oncology.
Z Gastroenterol.
2000;
38
49-75
Reference Ris Wihthout Link
- 4
Thomas-Gibson S, Rogers P, Cooper S. et al .
Judgement of the quality of bowel preparation at screening flexible sigmoidoscopy
is associated with variability in adenoma detection rates.
Endoscopy.
2006;
38
456-460
Reference Ris Wihthout Link
- 5
Froehlich F, Wietlisbach V, Gonvers J J. et al .
Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European
Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study.
Gastrointest Endosc.
2005;
61
378-384
Reference Ris Wihthout Link
- 6
Harewood G C, Sharma V K, Garmo de P.
Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia.
Gastrointest Endosc.
2003;
58
76-79
Reference Ris Wihthout Link
- 7
Kim W H, Cho Y J, Park J Y. et al .
Factors affecting insertion time and patient discomfort during colonoscopy.
Gastrointest Endosc.
2000;
52
600-660
Reference Ris Wihthout Link
- 8
Hurlstone D P, Cross S S, Adam I. et al .
A prospective clinicopathological and endoscopic evaluation of flat and depressed
colorectal lesions in the United Kingdom.
Am J Gastroenterol.
2003;
98
2543-2549
Reference Ris Wihthout Link
- 9
Suzuki N, Talbot I C, Saunders B P.
The prevalence of small, flat colorectal cancers in a western population.
Colorectal Dis.
2004;
6
15-20
Reference Ris Wihthout Link
- 10
Okamoto M, Kawabe T, Yamaji Y. et al .
Flat-type early colorectal cancer preferentially develops in right-sided colon in
older patients.
Dis Colon Rectum.
2005;
48
101-107
Reference Ris Wihthout Link
- 11
Reilly T, Walker G.
Reasons for poor colonic preparation with inpatients.
Gastroenterol Nurs.
2004;
27
115-117
Reference Ris Wihthout Link
- 12
Di Febo G, Chilovi F, Calabrese C. et al .
PEG-electrolyte solution: Efficacy and acceptability of four dose-regimens. Results
of a multicenter randomized study.
Giorn Ital End Dig.
1996;
19
255-259
Reference Ris Wihthout Link
- 13
Rosch T, Classen M.
Fractional cleansing of the large bowel with „Golytely” for colonoscopic preparation:
a controlled trial.
Endoscopy.
1987;
19
198-200
Reference Ris Wihthout Link
- 14
Momsen O H.
Peroral cleansing for coloscopy - a possibility of establishing ambulatory coloscopy
service.
Ugeskr Laeger.
1993;
155
1968-1970
Reference Ris Wihthout Link
- 15
El S ayed AM, Kanafani Z A, Mourad F H. et al .
A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte
solution for colonoscopy preparation.
Gastrointest Endosc.
2003;
58
36-40
Reference Ris Wihthout Link
- 16
Church J M.
Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy
- timing is the key!.
Dis Colon Rectum.
1998;
41
1223-1225
Reference Ris Wihthout Link
- 17
Chakravarty B J, Fraser A, Hamilton I. et al .
A randomised blinded study in colonic lavage for colonoscopy.
Aust N Z J Med.
1991;
21
769-771
Reference Ris Wihthout Link
- 18
Aoun E, Abdul-Baki H, Azar C. et al .
A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary
restriction compared with whole dose PEG-electrolyte solution with dietary restriction
for colonoscopy preparation.
Gastrointest Endosc.
2005;
62
213-218
Reference Ris Wihthout Link
- 19
Shah N, Sanaka M R, Mullen K D. et al .
Afternoon colonoscopies have higher failure rates compard to morning colonoscopies.
Gastrointest Endosc.
2005;
61
AB15
Reference Ris Wihthout Link
- 20
Ness R M, Manam R, Hoen H. et al .
Predictors of inadequate bowel preparation for colonoscopy.
Am J Gastroenterol.
2001;
96
1797-1802
Reference Ris Wihthout Link
- 21
Rostom A, Jolicoeur E, Dube C. et al .
A randomized prospective trial comparing different regimens of oral sodium phosphate
and polyethylene glycol-based lavage solution in the preparation of patients for colonoscopy.
Gastrointest Endosc.
2006;
64
544-552
Reference Ris Wihthout Link
- 22
Kim H S, Park D H, Kim J W. et al .
Effectiveness of walking exercise as a bowel preparation for colonoscopy: a randomized
controlled trial.
Am J Gastroenterol.
2005;
100
1964-1969
Reference Ris Wihthout Link
- 23
Matter S E, Rice P S, Campbell D R.
Colonic lavage solutions: plain versus flavored.
Am J Gastroenterol.
1993;
88
49-52
Reference Ris Wihthout Link
- 24
Bitoun A, Ponchon T, Barthet M. et al .
Results of a prospective randomised multicentre controlled trial comparing a new 2-L
ascorbic acid plus polyethylene glycol and electrolyte solution vs. sodium phosphate
solution in patients undergoing elective colonoscopy.
Aliment Pharmacol Ther.
2006;
24
1631-1642
Reference Ris Wihthout Link
- 25
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
Reference Ris Wihthout Link
- 26
Belsey J, Epstein O, Heresbach D.
Systematic review: oral bowel preparation for colonoscopy.
Aliment Pharmacol Ther.
2007;
25
373-384
Reference Ris Wihthout Link
- 27
Ell C, Gruss H J. et al .
Results of a randomised, multi-centre, single-blind trial to compare the efficacy,
acceptability and safety of a new 2-litre gut cleansing solution versus a standard
4-litre PEG+E solution.
Am J Gastro.
2008;
in press
Reference Ris Wihthout Link
- 28
Ell C, Fischbach W, Layer P. et al .
Polyethylene glycol with electrolytes and ascorbic acid versus sodium phosphate for
bowel cleansing before colonoscopy for cancer screening: a randomized, controlled
trial.
Endoscopy.
2008 (HSG-03); in press;
Reference Ris Wihthout Link
- 29
Tan J J, Tjandra J J.
Which is the optimal bowel preparation for colonoscopy - a meta-analysis.
Colorectal Dis.
2006;
8
247-258
Reference Ris Wihthout Link
- 30
Wexner S D, Beck D E, Baron T H. et al .
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).
Gastrointest Endosc.
2006;
63
894-909
Reference Ris Wihthout Link
- 31
Felt-Bersma R J, Kooyman G, Kuipers E J.
Colonic lavage prior to colonoscopy: comparable outcomes of two polyethylene-glycol
preparations and a sodium-phosphate solution.
Ned Tijdschr Geneeskd.
2004;
148
181-185
Reference Ris Wihthout Link
- 32
Cohen S M, Wexner S D, Binderow S R. et al .
Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing
methods.
Dis Colon Rectum.
1994;
37
689-696
Reference Ris Wihthout Link
- 33
Campisi P, Badhwar V, Morin S. et al .
Postoperative hypocalcemic tetany caused by fleet phospho-soda preparation in a patient
taking alendronate sodium: report of a case.
Dis Colon Rectum.
1999;
42
1499-1501
Reference Ris Wihthout Link
- 34
Vukasin P, Weston L A, Beart R W.
Oral Fleet Phospho-Soda laxative-induced hyperphosphatemia and hypocalcemic tetany
in an adult: report of a case.
Dis Colon Rectum.
1997;
40
497-499
Reference Ris Wihthout Link
- 35
Clarkston W K, Tsen T N, Dies D F. et al .
Oral sodium phosphate versus sulfate-free polyethylene glycol electrolyte lavage solution
in outpatient preparation for colonoscopy: a prospective comparison.
Gastrointest Endosc.
1996;
43
42-48
Reference Ris Wihthout Link
- 36
Mathus-Vliegen E M, Kemble U M.
A prospective randomized blinded comparison of sodium phosphate and polyethylene glycol-electrolyte
solution for safe bowel cleansing.
Aliment Pharmacol Ther.
2006;
23
543-552
Reference Ris Wihthout Link
- 37
Ainley E J, Winwood P J, Begley J P.
Measurement of serum electrolytes and phosphate after sodium phosphate colonoscopy
bowel preparation: an evaluation.
Dig Dis Sci.
2005;
50
1319-1323
Reference Ris Wihthout Link
- 38
Aradhye S, Brensilver J M.
Sodium phosphate-induced hypernatremia in an elderly patient: a complex pathophysiologic
state.
Am J Kidney Dis.
1991;
18
609-611
Reference Ris Wihthout Link
- 39
Golub R W, Kerner B A, Wise W E Jr. et al .
Colonoscopic bowel preparations - which one? A blinded, prospective, randomized trial.
Dis Colon Rectum.
1995;
38
594-599
Reference Ris Wihthout Link
- 40
Huynh T, Vanner S, Paterson W.
Safety profile of 5-h oral sodium phosphate regimen for colonoscopy cleansing: lack
of clinically significant hypocalcemia or hypovolemia.
Am J Gastroenterol.
1995;
90
104-107
Reference Ris Wihthout Link
- 41
Tan H L, Liew Q Y, Loo S. et al .
Severe hyperphosphataemia and associated electrolyte and metabolic derangement following
the administration of sodium phosphate for bowel preparation.
Anaesthesia.
2002;
57
478-483
Reference Ris Wihthout Link
- 42
Markowitz G S, Nasr S H, Klein P. et al .
Renal failure due to acute nephrocalcinosis following oral sodium phosphate bowel
cleansing.
Hum Pathol.
2004;
35
675-684
Reference Ris Wihthout Link
- 43
Frizelle F A, Colls B M.
Hyponatremia and seizures after bowel preparation: report of three cases.
Dis Colon Rectum.
2005;
48
393-396
Reference Ris Wihthout Link
- 44 Center for Drug Evaluation and Research .Safety of sodium phosphates oral solution. Washington; Food and Drug Administration 2005
Reference Ris Wihthout Link
- 45
Berkelhammer C, Ekambaram A, Silva R G.
Low-volume oral colonoscopy bowel preparation: sodium phosphate and magnesium citrate.
Gastrointest Endosc.
2002;
56
89-94
Reference Ris Wihthout Link
- 46
Barclay R L.
Safety, efficacy, and patient tolerance of a three-dose regimen of orally administered
aqueous sodium phosphate for colonic cleansing before colonoscopy.
Gastrointest Endosc.
2004;
60
527-533
Reference Ris Wihthout Link
- 47
Guller R, Reichlin B, Jost G.
Colonic preparation with sodium phosphate. Prospective, randomized, placebo-controlled
double blind study with various antiemetics.
Schweiz Med Wochenschr.
1996;
126
1352-1357
Reference Ris Wihthout Link
- 48
Balaban D H, Leavell B S Jr, Oblinger M J. et al .
Low volume bowel preparation for colonoscopy: randomized, endoscopist-blinded trial
of liquid sodium phosphate versus tablet sodium phosphate.
Am J Gastroenterol.
2003;
98
827-832
Reference Ris Wihthout Link
- 49
Hsu C W, Imperiale T F.
Meta-analysis and cost comparison of polyethylene glycol lavage versus sodium phosphate
for colonoscopy preparation.
Gastrointest Endosc.
1998;
48
276-282
Reference Ris Wihthout Link
- 50
Vanner S J, MacDonald P H, Paterson W G. et al .
A randomized prospective trial comparing oral sodium phosphate with standard polyethylene
glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy.
Am J Gastroenterol.
1990;
85
422-427
Reference Ris Wihthout Link
- 51
Aronchick C A, Lipshutz W H, Wright S H. et al .
A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons
with Colyte and Fleet Phospho-Soda.
Gastrointest Endosc.
2000;
52
346-352
Reference Ris Wihthout Link
- 52
Henderson J M, Barnett J L, Turgeon D K. et al .
Single-day, divided-dose oral sodium phosphate laxative versus intestinal lavage as
preparation for colonoscopy: efficacy and patient tolerance.
Gastrointest Endosc.
1995;
42
238-243
Reference Ris Wihthout Link
- 53
Frommer D.
Cleansing ability and tolerance of three bowel preparations for colonoscopy.
Dis Colon Rectum.
1997;
40
100-104
Reference Ris Wihthout Link
- 54
Kastenberg D, Barish C, Burack H. et al .
Tolerability and patient acceptance of sodium phosphate tablets compared with 4-L
PEG solution in colon cleansing: combined results of 2 identically designed, randomized,
controlled, parallel group, multicenter phase 3 trials.
J Clin Gastroenterol.
2007;
41
54-61
Reference Ris Wihthout Link
- 55
Tjandra J J, Chan M, Tagkalidis P P.
Oral sodium phosphate (Fleet) is a superior colonoscopy preparation to Picopre (sodium
picosulfate-based preparation).
Dis Colon Rectum.
2006;
49
616-620
Reference Ris Wihthout Link
- 56
Bigard M A, Gaucher P, Lassalle C.
Fatal colonic explosion during colonoscopic polypectomy.
Gastroenterology.
1979;
77
1307-1310
Reference Ris Wihthout Link
- 57
Rerknimitr R.
Sorbitol can be the cause of colonic explosion.
Endoscopy.
2007;
39
257
Reference Ris Wihthout Link
- 58
Kositchaiwat S, Suwanthanmma W, Suvikapakornkul R. et al .
Comparative study of two bowel preparation regimens for colonoscopy: senna tablets
vs sodium phosphate solution.
World J Gastroenterol.
2006;
12
5536-5539
Reference Ris Wihthout Link
- 59
Avgerinos A, Kalantzis N, Rekoumis G. et al .
Bowel preparation and the risk of explosion during colonoscopic polypectomy.
Gut.
1984;
25
361-364
Reference Ris Wihthout Link
- 60
Lazzaroni M, Petrillo M, Desideri S. et al .
Efficacy and tolerability of polyethylene glycol-electrolyte lavage solution with
and without simethicone in the preparation of patients with inflammatory bowel disease
for colonoscopy.
Aliment Pharmacol Ther.
1993;
7
655-659
Reference Ris Wihthout Link
- 61
Lind E, Wiig J N.
Peroral emptying of the colon. A randomized comparison of 4 and 1.5 liter regimens.
Tidsskr Nor Laegeforen.
1990;
110
1357-1358
Reference Ris Wihthout Link
- 62
Huppertz-Hauss G, Bretthauer M, Sauar J. et al .
Polyethylene glycol versus sodium phosphate in bowel cleansing for colonoscopy: a
randomized trial.
Endoscopy.
2005;
37
537-541
Reference Ris Wihthout Link
- 63 Center for Drug Evaluation and Research .Food and Drug Administration Science Backgrounder: Safety of Sodium Phosphates Oral
Solution. Washington; Center for Drug Evaluation and Research 2001
Reference Ris Wihthout Link
- 64 Bundesamt für Sicherheit im Gesundheitswesen .Wichtiger Hinweis bezüglich des Austretens schwerwiegender Nebenwirkungen bei Fleet
Phopho-soda und magistralen Zubereitungen. Montreal, Wien; Österreichische Agentur für Gesundheit und Ernährungssicherheit GmbH 2006
Reference Ris Wihthout Link
- 65
Beloosesky Y, Grinblat J, Weiss A. et al .
Electrolyte disorders following oral sodium phosphate administration for bowel cleansing
in elderly patients.
Arch Intern Med.
2003;
163
803-808
Reference Ris Wihthout Link
- 66
Barclay R L, Depew W T, Vanner S J.
Carbohydrate-electrolyte rehydration protects against intravascular volume contraction
during colonic cleansing with orally administered sodium phosphate.
Gastrointest Endosc.
2002;
56
633-638
Reference Ris Wihthout Link
- 67
Taylor C, Schubert M L.
Decreased efficacy of polyethylene glycol lavage solution (golytely) in the preparation
of diabetic patients for outpatient colonoscopy: a prospective and blinded study.
Am J Gastroenterol.
2001;
96
710-714
Reference Ris Wihthout Link
- 68
Da Silva M M, Briars G L, Patrick M K. et al .
Colonoscopy preparation in children: safety, efficacy, and tolerance of high- versus
low-volume cleansing methods.
J Pediatr Gastroenterol Nutr.
1997;
24
33-37
Reference Ris Wihthout Link
- 69
Gremse D A, Sacks A I, Raines S.
Comparison of oral sodium phosphate to polyethylene glycol-based solution for bowel
preparation for colonoscopy in children.
J Pediatr Gastroenterol Nutr.
1996;
23
586-590
Reference Ris Wihthout Link
- 70
Marschall H U, Bartels F.
Life-threatening complications of nasogastric administration of polyethylene glycol-electrolyte
solutions (Golytely) for bowel cleansing.
Gastrointest Endosc.
1998;
47
408-410
Reference Ris Wihthout Link
Prof. Dr. C. Ell
Medizinische Klinik II, Dr.-Horst-Schmidt-Kliniken GmbH
Ludwig-Erhard-Straße 100
65199 Wiesbaden
Phone: ++ 49/6 11/43 24 20
Fax: ++ 49/6 11/43 24 18
Email: ell.hsk-wiesbaden@arcor.de