Background and Aims
Split-dose bowel preparation for colonoscopy results in superior preparation quality.
However, some endoscopy units remain hesitant to prescribe split-dose preparation
given theoretical concerns about possible aspiration caused by gastric residual fluid
when a second dose is given close to the time of endoscopy. Our aim was to compare
gastric residual volume (GRV) in patients taking split-dose bowel preparation and
those taking preparation the evening before colonoscopy.
Methods
We performed a prospective observational comparison of GRV among random inpatients
undergoing same-day EGD and colonoscopy either after a split-dose bowel preparation
or after a bowel preparation the prior evening.
Results
GRV was measured in 150 patients undergoing EGD and colonoscopy: 75 who completed
a split-dose bowel preparation 2 to 3 hours before endoscopy and 75 who completed
the bowel preparation regimen the prior evening. The mean GRV 2 to 3 hours after the
last ingestion of bowel preparation among split-dose group patients was 21 ± 24 mL
(± standard deviation; range, 0 to 125 mL), which was not different from the mean
GRV of 24 ± 22 mL (range, 0 to 135 mL) in patients who ingested the preparation the
prior evening (P = .08). GRV had no association with the presence of diabetes, gastroparesis, or opioid
use.
Conclusions
GRV is the same after a split preparation and fasting for 2 to 3 hours or after preparation
with overnight fasting. The data suggest that the risk of aspiration is identical
after either preparation technique and thus that sedation for colonoscopy can be performed
safely 2 hours after bowel preparation ingestion.
Abbreviations:
GRV (gastric residual volume), PEG (polyethylene glycol)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The impact of colon preparation timing on colonoscopic detection of colorectal neoplasms–a prospective endoscopist-blinded randomized trial.Am J Gastroenterol. 2006; 101: 2719-2725
- Split dosing of bowel preparations for colonoscopy: an analysis of its efficacy, safety, and tolerability.Gastrointest Endosc. 2010; 72: 406-412
- A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation.Gastrointest Endosc. 2003; 58: 36-40
- 4-Liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2012; 10: 1225-1231
- Comparison of two schedules (previous evening versus same morning) of bowel preparation for colonoscopy.Endoscopy. 2007; 39: 706-709
- Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials.Gastrointest Endosc. 2011; 73: 1240-1245
- Quality and effect of single dose versus split dose of polyethylene glycol bowel preparation for early-morning colonoscopy.Endoscopy. 2007; 39: 616-619
- The timing of bowel preparation before colonoscopy determines the quality of cleansing, and is a significant factor contributing to the detection of flat lesions: a randomized study.World J Gastroenterol. 2006; 12: 6161-6166
- Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer.Gastroenterology. 2014; 147: 903-924
- Willingness to undergo split-dose bowel preparation for colonoscopy and compliance with split-dose instructions.Dig Dis Sci. 2010; 55: 2030-2034
- Acceptance of split-dose bowel preparation regimen for colonoscopy by patients and providers.J Clin Gastroenterol. 2014; 48: e47-e49
- Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters.Anesthesiology. 2011; 114: 495-511
- Bowel preparation with polyethylene glycol electrolyte solution: optimizing the splitting regimen.Dig Liver Dis. 2012; 44: 576-579
- Reducing the risk of acid aspiration during cesarean section.Anesth Analg. 1974; 53: 859-868
- At risk for aspiration: new critical values of volume and pH?.Anesth Analg. 1993; 76: 666
- Gastric fluid volume: is it really a risk factor for pulmonary aspiration?.Anesth Analg. 1998; 87: 754-756
- Split-dose bowel preparation for colonoscopy and residual gastric fluid volume: an observational study.Gastrointest Endosc. 2010; 72: 516-522
- Factors that affect gastric passage of video capsule.Gastrointest Endosc. 2005; 62: 785-790
- Review article: the role of gastric motility in the control of food intake.Aliment Pharmacol Ther. 2011; 33: 880-894
- Polyethylene glycol electrolyte solution and sedation intervals—are we clear for take off yet [abstract]?.Gastrointest Endosc. 2013; 77: AB515
- Do HbA1C levels correlate with delayed gastric emptying in diabetic patients?.J Neurogastroenterol Motil. 2010; 16: 414-417
- Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population.Am J Gastroenterol. 2012; 107: 82-88
- Gastric emptying of solids and liquids for evaluation for gastroparesis.Dig Dis Sci. 2011; 56: 1138-1146
- Opioid-induced delay in gastric emptying: a peripheral mechanism in humans.Anesthesiology. 1997; 87: 765-770
- The timing of bowel preparation is more important than the timing of colonoscopy in determining the quality of bowel cleansing.Dig Dis Sci. 2011; 56: 539-544
- 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.Gastrointest Endosc. 2010; 72: 313-320
- Does age affect gastric emptying time? A model-based meta-analysis of data from premature neonates through to adults.Biopharm Drug Dispos. 2015; 36: 245-257
- Gastric emptying in diabetes: clinical significance and treatment.Diabet Med. 2002; 19: 177-194
Article info
Publication history
Published online: September 14, 2015
Accepted:
August 19,
2015
Received:
April 14,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Agrawal at [email protected]
Identification
Copyright
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
