Abstract

Adequate colonic cleansing is essential for a high quality colonoscopy. Few studies have investigated the association between patient education and quality of bowel preparation. The control group comprised 165 participants who underwent colonoscopy after a standard bowel preparation protocol during the period September–October 2013 and the study group comprised 251 individuals who underwent colonoscopy after a modified bowel preparation protocol during the period January–February 2014. The modified bowel preparation protocol included an instructional video and leaflet, a dietician-designed 2-day low fiber diet, a follow-up phone message, and information to confirm stool characteristics. The Aronchick Bowel Preparation Scale was used to define the quality of bowel preparation. The endoscopists who performed the procedures were blinded to the preparation protocols. The percentage of participants with excellent bowel preparation quality was significantly higher in the study group than in the control group (35.9% vs. 21.8%, p = 0.002). Also, the percentage of participants with poorly prepared bowels was significantly higher in the control group than in the study group (3% vs. 0.8%, p = 0.042). Moreover, the adenoma detection rate was significantly higher in the study group (35.1% vs. 24.8%, p = 0.028). The results show that the quality of bowel cleansing can be improved by providing patients with a modified bowel preparation protocol.

Abstract

The technical complexity of endoscopic submucosal dissection (ESD) demands adequate training to lower the surgical risks. The diameter and mucosal structure of the porcine colon is similar to the human colon making the pig a good animal for colonoscopic procedure training. However, a standardized animal bowel preparation used in colonic ESD training has not been established. Colonoscopic procedures were performed in 12 pigs, divided into four groups. The control group (Group 1) fasted and received no preprocedure preparation. Group 2 received a single dose of sodium phosphate 2 mL/kg, Group 3 and Group 4 received split doses of sodium phosphate (2 mL/kg and 4 mL/kg, respectively). An experienced endoscopist, blinded to the preparation method, assigned a score from excellent (4 points) to poor (1 point) at five regions of the colon. The final mean bowle cleansing score was calculated from five regions in each pig. Serum biochemistry and electrolyte levels were analyzed. The different doses of sodium phosphate preparations did not change the serum glucose, creatinine, sodium, potassium, calcium, or phosphorus levels. The colonic cleansing scores in Group 1 (1.3 ± 0.4, mean ± standard deviation) and Group 2 (1.5 ± 0.2) were lower than those of Group 3 (2.6 ± 0.6) and Group 4 (3 ± 0.2). The use of oral sodium phosphate is easy and safe in porcine bowel preparation for ESD training. Bowel preparation using a split dose of 2 mL/kg or 4 mL/kg sodium phosphate produces an adequate bowel cleansing. The optimal dosage still needs to be established in a large-scale study.

Abstract

Adequate bowel preparation is an important quality indicator of colonoscopy. This study validated whether the bowel cleansing quality and adenoma detection rate (ADR) could be different between two bowel preparation schedules in individuals receiving health examinations. We enrolled individuals who had received a colonoscopy as part of the regimen for their health checkup program with split-dose phosphosoda for bowel preparation. Prior to December 31, 2012, the second dose of phosphosoda was administered at 10:00 pm before the day of the colonoscopy and the individuals were defined as the 10-pm group. After January 1, 2013, the schedule was changed to 4:00 am the same day as the colonoscopy and was defined as the 4-am group. The bowel cleansing quality was assessed using the Aronchick scale. A total of 431 individuals were included, 259 in the 10-pm group and 172 in the 4-am group. The 4-am group individuals had a higher rate of excellent or good bowel cleansing quality as compared with the 10-PM group (77.3% vs. 22%, respectively, p < 0.001). The ADR was also higher in the 4-am group than in the 10-pm group (36% vs. 25.5%, respectively, p = 0.019). Modifying the time schedule of bowel preparation could improve bowel cleansing quality and increase the colonic ADR in a health management center.

Abstract

We retrospectively evaluated the usefulness of sennoside as an agent for mechanical bowel preparation prior to elective colon cancer surgery. A total of 86 patients were given 12 mg of sennoside on the evening prior to resective surgery for colon cancer, followed by intravenous antimicrobial prophylaxis used on the day of surgery or until postoperative day 2. The incidence of surgical site infection in the study group was 4.7%, which was comparable to that in the historical control patients (3.5%, p > 0.99), who had received polyethylene glycol for mechanical bowel preparation prior to colon surgery. On multivariate logistic regression analysis, only body mass index (p = 0.04) was an independent significant factor affecting the surgical site infection. The intraoperative spillage was not influenced by the presence of stenosis, although the amount of fecal matter was higher in the upstream colon segment (p < 0.01) and downstream segment (p = 0.07) in patients with a stenotic lesion occupying more than two-thirds of the lumen (n = 29) than in those without such severe stenosis (n = 57). Sennoside seems to be an acceptable agent for mechanical bowel preparation even in patients with stenosis.