Background and Aims
It is known that sodium picosulfate–magnesium citrate (SPMC) bowel preparations are
effective, well tolerated and safe, and that split-dosing is more effective for colon
cleansing than previous-day regimens. Anesthetic guidelines consider that residual
gastric fluid is independent of clear liquid fasting times. However, reluctance to
use split-dosing persists. This may be due to limited data on residual gastric fluid
volumes (RGFVs) and split-dosing bowel preparations, and that these may not be perceived
as standard clear liquids. Furthermore, no studies are available on RGFV/residual
gastric fluid pH (RGFpH) and SPMC. We aimed to evaluate the cleansing effectiveness
and the RGFV/RGFpH achieved after an SPMC split-dosing regimen compared with a SPMC
previous-day regimen.
Methods
This was a single-center observational study. A total of 328 outpatients scheduled
for simultaneous EGD and colonoscopy and following a split-dosing or previous-day
regimen of SPMC were included. We prospectively measured colon cleanliness by using
the Ottawa Bowel Preparation Scale, RGFV, and RGFpH.
Results
Ottawa Bowel Preparation Scale scores for overall, right, mid-colon, and colon fluid
were significantly better in the split-dosing group. In the split-dosing group, the
3- to 4-hour fasting time consistently achieved the best cleansing quality. RGFV was
significantly lower in the split-dosing group (11.09 vs 18.62, P < .001). No significant differences in RGFpH were detected.
Conclusions
Split-dosing SPMC provides higher colon cleansing quality with lower RGFVs than previous-day
SPMC regimens. SPMC in split-dosing acts exactly as a standard clear liquid acts,
and thus anesthetic guidelines on this issue may be applied with no concerns.
Abbreviations:
FT (fasting time), NaP (sodium phosphate), OBPS (Ottawa Bowel Preparation Scale), PEG (polyethylene glycol), PPI (proton pump inhibitor), RGFpH (residual gastric fluid pH), RGFV (residual gastric fluid volume), SPMC (sodium picosulfate–magnesium citrate)To read this article in full you will need to make a payment
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References
- American College of Gastroenterology guidelines for colorectal cancer screening 2009.Am J Gastroenterol. 2009; 104 ([corrected]): 739-750
- Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials.Gastrointest Endosc. 2011; 73: 1240-1245
- Canadian association of gastroenterology position statement on screening individuals at average risk for developing colorectal cancer: 2010.Can J Gastroenterol. 2010; 24: 705-714
- Optimal bowel preparation–a practical guide for clinicians.Nat Rev Gastroenterol Hepatol. 2014; 11: 419-425
- Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer.Am J Gastroenterol. 2014; 109: 1528-1545
- 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
- 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
- Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia.Gastrointest Endosc. 2003; 58: 76-79
- Impact of bowel preparation on efficiency and cost of colonoscopy.Am J Gastroenterol. 2002; 97: 1696-1700
- A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy.Am J Gastroenterol. 2002; 97: 3186-3194
- A dual-action, low-volume bowel cleanser administered the day before colonoscopy: results from the SEE CLEAR II study.Am J Gastroenterol. 2013; 108: 401-409
- Split-dose administration of a dual-action, low-volume bowel cleanser for colonoscopy: the SEE CLEAR I study.Gastrointest Endosc. 2013; 78: 132-141
- Sodium picosulfate/magnesium citrate: a review of its use as a colorectal cleanser.Drugs. 2009; 69: 123-136
- Comparison of two bowel preparations for colonoscopy: sodium picosulphate with magnesium citrate versus sulphate-free polyethylene glycol lavage solution.Am J Gastroenterol. 1998; 93: 1478-1482
- Which is the optimal bowel preparation for colonoscopy - a meta-analysis.Colorectal Dis. 2006; 8: 247-258
- 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
- Split dosing of bowel preparations for colonoscopy: an analysis of its efficacy, safety, and tolerability.Gastrointest Endosc. 2010; 72: 406-412
- Residue-free sodium phosphate tablets (OsmoPrep) versus visicol for colon cleansing: a randomized, investigator-blinded trial.Gastrointest Endosc. 2007; 65: 660-670
- Increased adenoma detection rate with system-wide implementation of a split-dose preparation for colonoscopy.Gastrointest Endosc. 2012; 76: 603-608.e1
- Split-dose picosulfate, magnesium oxide, and citric acid solution markedly enhances colon cleansing before colonoscopy: a randomized, controlled trial.Gastrointest Endosc. 2012; 75: 537-544
- Randomized controlled trial comparing efficacy and acceptability of split- and standard-dose sodium picosulfate plus magnesium citrate for bowel cleansing prior to colonoscopy.Endoscopy. 2014; 46: 662-669
- 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).Surg Endosc. 2006; 20: 1161
- Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline.Endoscopy. 2013; 45: 142-150
- Fluid deprivation before operation. The effect of a small drink.Anaesthesia. 1989; 44: 632-634
- Preoperative drinking does not affect gastric contents.Br J Anaesth. 1993; 70: 6-9
- Preoperative fasting for adults to prevent perioperative complications.Cochrane Database Syst Rev. 2003; 4: CD004423
- “Nil per oral after midnight”: is it necessary for clear fluids?.Indian J Anaesth. 2010; 54: 445-447
- 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
- Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology.Eur J Anaesthesiol. 2011; 28: 556-569
- Small doses of the unabsorbable substance polyethylene glycol 3350 accelerate oro-caecal transit, but slow gastric emptying in healthy subjects.Dig Liver Dis. 2005; 37: 97-101
- Effect of oral purgatives on gastric and small bowel transit time in capsule endoscopy.Isr Med Assoc J. 2004; 6: 521-523
- Split-dose bowel preparation for colonoscopy and residual gastric fluid volume: an observational study.Gastrointest Endosc. 2010; 72: 516-522
- Validation of a new scale for the assessment of bowel preparation quality.Gastrointest Endosc. 2004; 59: 482-486
- Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study.Gastrointest Endosc. 2012; 75: 583-590
- Predictors of inadequate bowel preparation for colonoscopy.Am J Gastroenterol. 2001; 96: 1797-1802
- Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea.J Clin Gastroenterol. 2009; 43: 448-452
- A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy.Clin Gastroenterol Hepatol. 2012; 10: 501-506
- Chronic methadone use, poor bowel visualization and failed colonoscopy: a preliminary study.World J Gastroenterol. 2012; 18: 4350-4356
- A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy.Am J Gastroenterol. 2009; 104: 2275-2284
- 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
- Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study.J Natl Cancer Inst. 2010; 102: 89-95
- Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality.Gastrointest Endosc. 2009; 69: 700-706
- Effect of i.v. omeprazole on the pH and volume of gastric contents before surgery.Br J Anaesth. 1989; 63: 536-540
- A comparison of the effects of ranitidine and omeprazole on volume and pH of gastric contents in elective surgical patients.Eur J Anaesthesiol. 2004; 21: 260-264
- Single-dose oral omeprazole for reduction of gastric residual acidity in adults for outpatient surgery.Acta Anaesthesiol Scand. 1992; 36: 513-515
- The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials.Anaesthesia. 2009; 64: 652-657
- Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients.Can J Anaesth. 2004; 1: 111-115
- Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy.Gastrointest Endosc. 2012; 76: 804-811
- Telephone-based re-education on the day before colonoscopy improves the quality of bowel preparation and the polyp detection rate: a prospective, colonoscopist-blinded, randomised, controlled study.Gut. 2014; 63: 125-130
Article info
Publication history
Published online: August 11, 2015
Accepted:
June 20,
2015
Received:
March 15,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
