[Bowel preparation in patients with Diabetes mellitus: Development of a procedure model].

Hintergrund Der Schlüsselfaktor für die Aussagekraft einer Koloskopie ist die Qualität der Darmvorbereitung (Kolonlavage). Eine schlechte Darmvorbereitung führt zu verlängerten Untersuchungszeiten, inkompletten Untersuchungen und erhöht das Komplikationsrisiko. Eine Diabeteserkrankung ist ein bedeutender Risikofaktor für eine insuffiziente Kolonlavage. Standardisierte Empfehlungen zur Koloskopievorbereitung von Diabetespatienten liegen bisher nicht vor. Methode Es erfolgte eine selektive Literatursuche in PubMed und GoogleScholar bis einschließlich 06/2021. Leitlinien und Positionspapiere der deutschen, europäischen und amerikanischen Fachgesellschaften sowie klinikeigene Erfahrungen wurden ebenfalls berücksichtigt. Ergebnisse Für die Darmvorbereitung gibt es verschiedene Wirkstoffe, die in 2 Hauptgruppen aufgeteilt werden können: Polyethylenglycol (PEG)-Lösungen und osmotische Lösungen. Es liegen inzwischen eine Reihe von Metaanalysen vor, die Unterschiede in den verschiedenen Vorbereitungsschemata untersucht haben. Die Ergebnisse sind sehr heterogen. Neben der Wahl des Abführmittels und der Frage welcher Zeitpunkt der Einnahme günstig ist, scheint die Art der Aufklärung zur Darmvorbereitung eine entscheidende Rolle zu spielen. Außerdem ist bei Diabetes-Patienten die Ernährung in den Tagen vor der Koloskopie von besonderer Bedeutung. Schlussfolgerung PEG-basierte Abführlösungen in Split-Dosis sind bei Diabetes-Patienten aufgrund der häufig vorliegenden Motilitätsstörungen zu bevorzugen. Eine subtile Aufklärung über die Abführmaßnahmen und ein individueller Ernährungsplan für die Tage vor der Koloskopie werden empfohlen.

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