Consensus guidelines for the use of bowel preparation prior to colonic diagnostic procedures: colonoscopy and small bowel video capsule endoscopy

Abstract Background: Adequate bowel preparation prior to colonic diagnostic procedures is essential to ensure adequate visualisation. Scope: This consensus aims to provide guidance as to the appropriate use of bowel preparation for a range of defined clinical circumstances. A consensus group from across Europe was convened and met to discuss appropriate bowel preparation. The use of polyethylene glycol (PEG), sodium picosulphate and sodium phosphate (NaP), together with other agents, prokinetics and simethicone, in colonoscopy and small bowel video capsule endoscopy were considered. A systematic review of the literature was carried out and additional unpublished data was obtained from the members of the consensus group where required. Recommendations were graded according to the level of evidence. Findings: PEG-based regimens are recommended first line for both procedures, since their use is supported by good efficacy and safety data. Sodium-picosulphate-based regimens are recommended second line as their cleansing efficacy appears less than PEG-based regimens. NaP is not recommended for bowel cleansing due to the potential for renal damage and other adverse events. However, the use of NaP is acceptable in patients in whom PEG or sodium picosulphate is ineffective or not tolerated. NaP should not be used in patients with chronic kidney disease, pre-existing electrolyte disturbances, congestive heart failure, cirrhosis or a history of hypertension. The timing of the dose, dietary restrictions, use in special patient groups and recording of the quality of bowel preparation are also considered for patients undergoing colonoscopy. During the development of the guidelines the European Society of Gastrointestinal Endoscopy (ESGE) issued guidance on bowel preparation for colonoscopy. The ESGE guidelines and these consensus guidelines share many recommendations; differences between the guidelines are reviewed. Conclusion: The use of bowel preparation should be tailored to the individual patient and their specific clinical circumstances.

[1]  Oxford Centre for Evidence-based Medicine Levels of Evidence (January 2001) , 2014 .

[2]  D. Rex,et al.  Split-dose administration of a dual-action, low-volume bowel cleanser for colonoscopy: the SEE CLEAR I study. , 2013, Gastrointestinal endoscopy.

[3]  D. Heresbach,et al.  Validation of the Harefield Cleansing Scale: a tool for the evaluation of bowel cleansing quality in both research and clinical practice. , 2013, Gastrointestinal endoscopy.

[4]  D. Rex,et al.  A Dual-Action, Low-Volume Bowel Cleanser Administered the Day Before Colonoscopy: Results From the SEE CLEAR II Study , 2013, The American Journal of Gastroenterology.

[5]  L. Mahajan,et al.  Tolerability, Safety, and Efficacy of PEG 3350 as a 1-day Bowel Preparation in Children , 2013, Journal of pediatric gastroenterology and nutrition.

[6]  R. Bryant,et al.  Shorter preparation to procedure interval for colonoscopy improves quality of bowel cleansing , 2013, Internal medicine journal.

[7]  C. Nylund,et al.  Prospective Evaluation of 1-Day Polyethylene Glycol-3350 Bowel Preparation Regimen in Children , 2013, Journal of pediatric gastroenterology and nutrition.

[8]  Mei Lin Chen-Lim,et al.  Polyethylene Glycol Powder Solution Versus Senna for Bowel Preparation for Colonoscopy in Children , 2013, Journal of pediatric gastroenterology and nutrition.

[9]  C. Hassan,et al.  Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline , 2013, Endoscopy.

[10]  S. Jung,et al.  Polyethylene glycol bowel preparation does not eliminate the risk of acute renal failure: a population-based case-crossover study , 2014, Endoscopy.

[11]  C. Crosta,et al.  Meta-analysis: efficacy of small bowel preparation for small bowel video capsule endoscopy , 2012, Current medical research and opinion.

[12]  B. Enestvedt,et al.  4-Liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis. , 2012, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[13]  D. Rex,et al.  Day-Before Administration of a Novel, Dual-Action, Low-Volume Bowel Cleanser for Colonoscopy: Efficacy and Safety Results from the SEE CLEAR II Study: 1832 , 2012 .

[14]  G. Fernández-Esparrach,et al.  La hora de ingesta del polietilenglicol es un factor clave en la tolerancia y eficacia de la preparación del colon en individuos de un programa poblacional de cribado de cáncer colorrectal , 2012 .

[15]  S. Vanner,et al.  Split-dose picosulfate, magnesium oxide, and citric acid solution markedly enhances colon cleansing before colonoscopy: a randomized, controlled trial. , 2012, Gastrointestinal endoscopy.

[16]  Jongha Park,et al.  Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study. , 2012, Gastrointestinal endoscopy.

[17]  R. Leicester,et al.  Budget-impact model for colonoscopy cost calculation and comparison between 2 litre PEG+ASC and sodium picosulphate with magnesium citrate or sodium phosphate oral bowel cleansing agents , 2012, Journal of medical economics.

[18]  H. Neuhaus,et al.  A pilot study evaluating a new low-volume colon cleansing procedure for capsule colonoscopy , 2012, Endoscopy.

[19]  G. Longcroft-Wheaton,et al.  Same-day Bowel Cleansing Regimen is Superior to a Split-dose Regimen Over Two Days for Afternoon Colonoscopy: Results From a Large Prospective Series , 2012, Journal of clinical gastroenterology.

[20]  C. Crosta,et al.  Meta‐analysis: the relative efficacy of oral bowel preparations for colonoscopy 1985–2010 , 2012, Alimentary pharmacology & therapeutics.

[21]  J. Llach,et al.  [Timing of polyethylene glycol administration is a key factor in the tolerability and efficacy of colon preparation in colorectal cancer screening]. , 2012, Gastroenterologia y hepatologia.

[22]  Hsiu‐Po Wang,et al.  Different Bowel Preparation Schedule Leads to Different Diagnostic Yield of Proximal and Nonpolypoid Colorectal Neoplasm at Screening Colonoscopy in Average-Risk Population , 2011, Diseases of the colon and rectum.

[23]  J. Ortiz Fernández-Sordo,et al.  Usefulness of an Intensive Bowel Cleansing Strategy for Repeat Colonoscopy After Preparation Failure , 2011, Diseases of the colon and rectum.

[24]  W. Midodzi,et al.  A randomized controlled trial of four precolonoscopy bowel cleansing regimens. , 2011, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[25]  B. Winkens,et al.  Preparation before colonoscopy: a randomized controlled trial comparing different regimes , 2011, European journal of gastroenterology & hepatology.

[26]  J. LaChance,et al.  The Utility of PEG3350 without Electrolytes for 2-Day Colonoscopy Preparation in Children , 2011, European Journal of Pediatric Surgery.

[27]  S. Husain,et al.  Two-day Bowel Preparation With Polyethylene Glycol 3350 and Bisacodyl: A New, Safe, and Effective Regimen for Colonoscopy in Children , 2011, Journal of pediatric gastroenterology and nutrition.

[28]  M. Matteson,et al.  Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. , 2011, Gastrointestinal endoscopy.

[29]  I. Lawrance,et al.  Bowel cleansing for colonoscopy: prospective randomized assessment of efficacy and of induced mucosal abnormality with three preparation agents. , 2011, Endoscopy.

[30]  M. Muñoz-Navas,et al.  Evaluation of Different Bowel Preparations for Small Bowel Capsule Endoscopy: A Prospective, Randomized, Controlled Study , 2011, Digestive Diseases and Sciences.

[31]  Yuan-Yuan Zhao,et al.  Small Bowel Preparations for Capsule Endoscopy With Mannitol and Simethicone: A Prospective, Randomized, Clinical Trial , 2011, Journal of clinical gastroenterology.

[32]  Ju-Young Kim,et al.  A population-based case-crossover study of polyethylene glycol use and acute renal failure risk in the elderly. , 2011, World journal of gastroenterology.

[33]  C. Liao,et al.  Systematic review and meta-analysis of randomized controlled trials of Simethicone for gastrointestinal endoscopic visibility , 2011, Scandinavian journal of gastroenterology.

[34]  C. Rayner,et al.  Impact of Low-Residue Diet on Bowel Preparation for Colonoscopy , 2011, Diseases of the colon and rectum.

[35]  Chang Duck Kim,et al.  Effect of Bowel Preparation with Polyethylene Glycol on Quality of Capsule Endoscopy , 2011, Digestive Diseases and Sciences.

[36]  M. Haapamäki,et al.  Low-volume bowel preparation is inferior to standard 4 l polyethylene glycol , 2011, Surgical Endoscopy.

[37]  D. Han,et al.  The Timing of Bowel Preparation Is More Important than the Timing of Colonoscopy in Determining the Quality of Bowel Cleansing , 2011, Digestive Diseases and Sciences.

[38]  M. Wieland,et al.  Risk factors predictive of poor quality preparation during average risk colonoscopy screening: the importance of health literacy. , 2010, Journal of gastrointestinal and liver diseases : JGLD.

[39]  Anand Kumar,et al.  Morning-Only One-Gallon Polyethylene Glycol Improves Bowel Cleansing for Afternoon Colonoscopies: A Randomized Endoscopist-Blinded Prospective Study , 2010, The American Journal of Gastroenterology.

[40]  Giovanni Riccio,et al.  Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low-volume polyethylene glycol solutions. , 2010, Gastrointestinal endoscopy.

[41]  F. Jamali,et al.  A randomized single-blind trial of standard diet versus fiber-free diet with polyethylene glycol electrolyte solution for colonoscopy preparation , 2010, Endoscopy.

[42]  G. Costamagna,et al.  Polyethylene glycol plus simethicone in small-bowel preparation for capsule endoscopy. , 2010, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[43]  A. Miranda,et al.  One-day bowel preparation with polyethylene glycol 3350: an effective regimen for colonoscopy in children. , 2010, Gastrointestinal endoscopy.

[44]  J. Rey,et al.  European Society of Gastrointestinal Endoscopy (ESGE): Recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases , 2010, Endoscopy.

[45]  D. Beck.  Bowel preparation for colonoscopy. , 2010, Clinics in colon and rectal surgery.

[46]  B. Jacobson,et al.  Comprehensive validation of the Boston Bowel Preparation Scale. , 2009, Gastrointestinal endoscopy.

[47]  Alfred I. Neugut,et al.  Socioeconomic and Other Predictors of Colonoscopy Preparation Quality , 2010, Digestive Diseases and Sciences.

[48]  A. Griffiths,et al.  Pico-Salax versus polyethylene glycol for bowel cleanout before colonoscopy in children: a randomized controlled trial. , 2009, Endoscopy.

[49]  M. Perazella,et al.  Acute phosphate nephropathy. , 2009, Kidney international.

[50]  J. D. Di Palma,et al.  Lubiprostone neither decreases gastric and small-bowel transit time nor improves visualization of small bowel for capsule endoscopy: a double-blind, placebo-controlled study. , 2009, Gastrointestinal endoscopy.

[51]  K. H. Park,et al.  Patient Factors Predictive of Inadequate Bowel Preparation Using Polyethylene Glycol: A Prospective Study in Korea , 2009, Journal of clinical gastroenterology.

[52]  C. Fraser,et al.  Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study. , 2009, Gastrointestinal endoscopy.

[53]  S. Brunelli.  Association between oral sodium phosphate bowel preparations and kidney injury: a systematic review and meta-analysis. , 2009, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[54]  B. Avidan,et al.  The outcome of a second preparation for colonoscopy after preparation failure in the first procedure. , 2009, Gastrointestinal endoscopy.

[55]  S. Spechler,et al.  Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality. , 2009, Gastrointestinal endoscopy.

[56]  D. Heresbach,et al.  Systematic review: adverse event reports for oral sodium phosphate and polyethylene glycol , 2009, Alimentary pharmacology & therapeutics.

[57]  Gheorghe Doros,et al.  The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. , 2007, Gastrointestinal endoscopy.

[58]  M. Esaki,et al.  Bowel preparations for capsule endoscopy: a comparison between simethicone and magnesium citrate. , 2009, Gastrointestinal endoscopy.

[59]  C. Ell,et al.  Randomized Trial of Low-Volume PEG Solution Versus Standard PEG + Electrolytes for Bowel Cleansing Before Colonoscopy , 2008, The American Journal of Gastroenterology.

[60]  Z. Ge,et al.  Purgative Bowel Cleansing Combined With Simethicone Improves Capsule Endoscopy Imaging , 2008, The American Journal of Gastroenterology.

[61]  K. Abbott,et al.  Association of oral sodium phosphate purgative use with acute kidney injury. , 2007, Journal of the American Society of Nephrology : JASN.

[62]  R. Diament,et al.  The impact of poor bowel preparation on colonoscopy: a prospective single centre study of 10 571 colonoscopies , 2007, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[63]  J. L. Ulla Rocha,et al.  [Bowel preparation for colonoscopy]. , 2007, Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva.

[64]  T. Ponchon,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 , 2006, Alimentary Pharmacology and Therapeutics.

[65]  Heitham Abdul-Baki,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. , 2005, Gastrointestinal endoscopy.

[66]  Bernard Burnand,et al.  Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. , 2005, Gastrointestinal endoscopy.

[67]  Welcome Guimera,et al.  Practice Guidelines for Sedation and Analgesia by Non- Anesthesiologists , 2005 .

[68]  C. Aronchick.  Bowel preparation scale. , 2004, Gastrointestinal endoscopy.

[69]  G. Walker,et al.  Reasons for Poor Colonic Preparation With Inpatients , 2004, Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates.

[70]  A. Rostom,et al.  Validation of a new scale for the assessment of bowel preparation quality. , 2004, Gastrointestinal endoscopy.

[71]  N. Chalasani,et al.  Predictors of inadequate bowel preparation for colonoscopy , 2001, American Journal of Gastroenterology.

[72]  M. Schubert,et al.  Decreased efficacy of polyethylene glycol lavage solution (Golytely) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study , 2001, American Journal of Gastroenterology.

[73]  V. Kottapalli,et al.  Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy--timing is the key? , 1999, Gastrointestinal endoscopy.

[74]  J. Church.  Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy—timing is the key! , 1998, Diseases of the colon and rectum.