Polyethylene Glycol Electrolyte Lavage Research Articles

Colonic lavage solutions

Many patients dislike the taste of the oral gastrointestinal lavage solutions utilized prior to colonoscopy. Specifically, patients dislike the salty taste and the quantity of the polyethylene glycol-electrolyte solution that they are required to ingest. In an attempt to reduce the salty taste and potentially improve patient compliance and tolerance of the preparation, flavoring was added to the lavage solution. Fifty-six patients received standard or flavored polyethylene glycol-electrolyte lavage solution in random order prior to colonoscopy. In group I, lemon-flavored Colyte was compared with standard Colyte: 93% (25/27) of subjects preferred the flavored solution. In group II, standard Colyte was compared with lemon/lime-flavored Colyte, and 80% (8/10) of subjects preferred standard Colyte. In group III, lemon-flavored Colyte, standard Colyte, and NuLYTELY were compared. Ninety percent (17/19) of the subjects preferred lemon-flavored Colyte, 10% of the subjects preferred standard Colyte, and none of the subjects preferred NuLYTELY. Overall, patients preferred lemon-flavored solution over other solutions.

Quantitative cultures of the mucosalassociated bacteria in the mechanically prepared colon and rectum

Little is known about the mucosal microflora of the colon and rectum at the time of elective surgery. Our objective was to determine the concentrations of anaerobic and aerobic bacteria associated with the mucosa of the mechanically prepared large bowel. Ten patients were studied after a standard polyethylene glycol-electrolyte lavage preparation. No patient had taken antibiotics in the preceding four weeks. Sterile wire brushes passed through the colonoscope during advancement were used to culture the rectal, transverse colon, and cecal mucosa. Total anaerobic, aerobic, Gram-positive, and enteric bacterial counts were determined along with specific cultures for Bacteroides fragilis, Clostridium difficile, Escherichia coli, Pseudomonas aeruginosa, enterococcus, and staphylococcus species. The results showed that there was a significant increase (P < 0.01) in aerobes, anaerobes, enterics, Gram positives, B. fragilis, and E. coli mucosal counts with proximal progression. Aerobes showed a steady gradient, while anaerobes demonstrated an increase from the rectum to the transverse colon but no change between the transverse colon and cecum. We conclude that, in the prepared bowel, there is an increase in the mucosal bacterial counts in the more proximal portions of the bowel. The results may serve as a baseline for future studies on the mucosal-associated bacteria of the large intestine.

Esophagogastroduodenoscopy for Suspected Gastrointestinal Deposits

The recent article by Young et al 1 suggests that colonoscopy and esophagogastroduodenoscopy should be performed early in the setting of suspected continued absorption from a gastrointestinal deposit. In justifying this, the authors describe a patient who swallowed a small plastic bag containing phencyclidine. After undergoing gastric lavage and activated charcoal administration the patient received 11 L of a polyethylene glycol electrolyte lavage solution (PEG-ELS) between days 11 and 14 (average of 150 mL/h) without packet passage. The plastic bag was eventually passed on hospital day 20. Because of this delay in passage, the authors conclude that esophagogastroduodenoscopy should be performed early to avoid potential complications. However, had the PEG-ELS been employed in proper whole-bowel irrigation (WBI) doses (2000 mL/h for an adult) instead of the cathartic doses (150 mL/h), this delay in packet passage might not have occurred. Correctly performed, WBI has been safely and effectively used as a

An in vitro evaluation of cocaine hydrochloride adsorption by activated charcoal and desorption upon addition of polyethylene glycol electrolyte lavage solution.

Cocaine body-packers and body-stuffers have become a common medical problem. Significant morbidity and mortality result when cocaine is absorbed from the gastrointestinal tract due to cocaine package compromise. The clinical prevention of gastrointestinal absorption of cocaine includes oral activated charcoal and/or whole bowel irrigation with polyethylene glycol--electrolyte lavage solution. This in vitro study investigates the maximal adsorptive capacity of activated charcoal for cocaine at varying activated charcoal:cocaine ratios, at pH 1.2 and pH 7.0, and the effect of polyethylene glycol--electrolyte lavage solution upon this binding. The percent adsorption of cocaine to activated charcoal was significantly better at pH 7.0 for all ratios of activated charcoal:cocaine tested and the maximal adsorptive capacity was 29% greater at pH 7.0 (273 micrograms/mg) than at pH 1.2 (212 micrograms/mg) (p < 0.05). Addition of polyethylene glycol--electrolyte lavage solution to the cocaine-activated charcoal slurry caused significant desorption of cocaine from activated charcoal at all pHs and ratios tested (except the 1:1 ratio at pH 7.0) and was most pronounced at pH 1.2. The addition of polyethylene glycol--electrolyte lavage solution to activated charcoal prior to adding cocaine solution further decreased the adsorption of cocaine to activated charcoal. This difference was significant at both pHs and all ratios tested except the 1:1 ratio at pH 1.2. The maximal adsorptive capacity of activated charcoal for cocaine at pH 1.2 was reduced 75% by pretreatment with polyethylene glycol--electrolyte lavage solution from 212 to 54.2 micrograms/mg, while at pH 7.0 the maximal adsorptive capacity was reduced by 11%, from 273 to 243 micrograms/mg. Polyethylene glycol--electrolyte lavage solution significantly reduces the adsorption of cocaine to activated charcoal particularly if the two are combined at a low pH prior to the addition of cocaine. The in vitro effects suggest that activated charcoal mixed in water should be administered first, followed by the polyethylene glycol--electrolyte lavage solution.

Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol–electrolyte lavage for colonoscopy preparation

We performed a prospective randomized trial in a predominantly outpatient colonoscopy population to see how preparation with oral sodium phosphate solution compares with polyethylene glycol-electrolyte lavage in terms of the quality of colon cleansing, ease of preparation, and gastrointestinal intolerance. Before colonoscopy, a nurse administered a questionnaire to the patient to assess how well the preparation was tolerated (scale from 1 to 5:1 = easy, to 5 = unable to finish) and about the presence of four symptoms: abdominal pain, nausea, vomiting, and dizziness. The quality of colon cleansing was graded by the attending gastroenterologist, who was unaware of how the patient was prepared or tolerated the preparation (1 = excellent, 2 = good, 3 = fair, 4 = poor). The overall quality of bowel preparation with polyethylene glycol lavage was slightly better than with sodium phosphate (mean score, 1.93 vs 2.07); however, the difference was not statistically different. No statistical difference was seen in the frequency of patients with poor preparations (14.2% for sodium phosphate, 9.6% for polyethylene glycol lavage). Patients found preparation with sodium phosphate to be somewhat easier than polyethylene glycol lavage (mean score, 2.07 vs 2.41; p = 0.05). No difference was seen in the incidence of abdominal pain, nausea, or vomiting. Dizziness was more common with sodium phosphate but was mild and not believed to be clinically important. We conclude that the quality of colon cleansing is similar with polyethylene glycol lavage and oral sodium phosphate solution, with satisfactory preparation seen in 85% to 90% of patients. Patients found preparation with sodium phosphate to be slightly easier to tolerate.(ABSTRACT TRUNCATED AT 250 WORDS)

Whole-bowel irrigation as adjunctive treatment for sustained-release theophylline overdose

To determine a therapeutic benefit for whole-bowel irrigation (with polyethylene glycol-electrolyte lavage solution) as adjunctive treatment to multiple doses of activated charcoal following an overdose of sustained-release theophylline. Randomized crossover study. Three treatment arms were separated by one-week intervals. Animal care facility housing. Eight female mongrel dogs. Unanesthetized dogs were given approximately 75 mg/kg of sustained-release theophylline. In treatment arm 1, 1 g/kg activated charcoal was administered by nasogastric tube at two hours after ingestion followed by 0.5-g/kg doses at five and eight hours. During treatment arm 2, beginning two hours after theophylline ingestion, 25 mL/kg whole-bowel irrigation solution was administered every 45 minutes for four doses followed by activated charcoal. In treatment arm 3, the first dose of activated charcoal was given ten minutes before beginning the whole-bowel irrigation protocol. Serum theophylline levels were measured at zero, two, four, five, eight, 12, 16, and 24 hours after ingestion. Mean serum theophylline levels, area under the curve (P = .13), and terminal half-lives (P = .69) for each treatment group were not statistically different. This negative study had an 81% power to detect a 50% reduction in the area under the curve by whole-bowel irrigation treatment. In this model, whole-bowel irrigation did not add to the therapeutic benefits of activated charcoal.

A study on polyethylene glycol electrolyte lavage solution and sodium picosulfate combined pretreatment method for colonoscopy.

As compared to a conventional PEG method, PEG-SP combined method required a less amount of PEG solution to be taken with a reduced pain of the patient involved, allowing a shortened time for examination.

Addition of senna improves colonoscopy preparation with lavage: a prospective randomized trial

Attempts have been made to further improve the widely performed colonoscopy preparation with lavage. In a prospective study, 120 outpatients and inpatients scheduled for total colonoscopy were randomized to two preparatory regimens. The day before endoscopy either extractum sennae (N = 60) or a placebo solution (N = 60) was given. Just before examination all patients underwent whole gut irrigation with a polyethylene glycol electrolyte lavage solution (PEG-ELS). Adequacy of preparation, patient tolerance, and the necessary amount of PEG-ELS were assessed. Physician assessment of colon cleansing showed superiority in the group with additional laxative. The colon was free of solid debris in 66.7% of patients after PEG-ELS and in 90% after senna/PEG-ELS administration (p less than 0.01). Patient tolerance was similar in both groups with 86.7% vs. 83.3% of subjects rating the preparation as tolerable. Severe adverse events were not observed. In the senna/PEG-ELS group, significantly less (p less than 0.05) lavage fluid was needed. We conclude that the combination of senna and PEG-ELS is more effective than PEG-ELS in cleansing the colon for colonoscopy.

Use of whole bowel irrigation in an infant following iron overdose

An 11-month-old, 11-kg infant presented to the emergency department after ingesting 130 to 150 mg/kg of elemental iron. Emesis was induced twice and the child was lavaged throughout a 4-hour period with some tablet return. An abdominal radiograph after gastrointestinal decontamination showed at least 16 whole iron tablets remaining in the stomach. Serum iron drawn 2 hours postingestion was 46.7 μmol/L. Blood glucose was 7.7 mmol/L and white blood count was 21,800 mm 3. Despite a second lavage 8 hours postingestion, a large number of whole tablets were visualized in the stomach per radiograph. Whole bowel irrigation with polyethylene glycol electrolyte lavage solution (Golytely, Braintree Laboratories, Inc, Braintree, MA) was begun via nasogastric tube 14 hours after the ingestion. Serial abdominal radiographs showed tablet movement out of the stomach within 4 hours after initiating whole bowel irrigation. This case demonstrates the safety and efficacy of WBI in an infant when conventional gastrointestinal decontamination has failed.

A New Oral Lavage Solution vs Cathartics and Enema Method for Preoperative Colonic Cleansing

Sulfate free-electrolyte lavage solution is a new osmotically balanced electrolyte gut lavage solution for colon surgery that has been formulated for improved taste and reduced water and electrolyte changes. Sixty patients were prospectively randomized to receive a 1-day preparation with sulfate free-electrolyte lavage solution or a 3-day preparation using a clear liquid diet, cathartics, and enemas. The patient groups were similar in age, race, male-female ratio, and the types of colonic resections performed. Colonic cleansing was better with sulfate free-electrolyte lavage solution (100% vs 63% "good" to "excellent" cleansing). Patient tolerance evaluated by a questionnaire showed more overall discomfort with sulfate free-electrolyte lavage solution but no difference between the preparations in individual symptoms of fullness, cramping, nausea, or vomiting. One patient developed a low level of serum potassium after a cathartic and enema preparation, while there were no complications with sulfate free-electrolyte lavage solution. Patient taste questionnaires showed a slight preference for sulfate free-electrolyte lavage solution (53%) over a polyethylene glycol electrolyte lavage solution (47%). This study confirms that sulfate free-electrolyte lavage solution is a safe and effective method of preoperative colonic cleansing.

Palatability of a new solution compared with standard polyethylene glycol solution for gastrointestinal lavage

The salty unpleasant taste of the standard polyethylene glycol electrolyte lavage solution constitutes a major drawback, which limits patient compliance. Recently, a new low-sodium cleansing solution was described and introduced as a major advance, allegedly providing a distinctly better taste and improving compliance. We compared the taste of both solutions, seeking a possible preference applying a double-blind randomized design. Twenty-eight healthy volunteers tasted one of the two solutions without a direct comparison. Both solutions were found to have a similar palatability and an equal salty taste. A different group of 50 volunteers compared the two solutions. Twenty-one preferred the standard solution, 25 preferred the new solution (not significant), and 4 subjects had no preference. Among the subjects basing their preference on the saltiness of the solutions, 18 estimated the standard solution to taste more salty than the new low sodium solution, while 18 volunteers found the new solution to taste more salty than the standard solution. This study does not confirm a taste preference for the new low-salt polyethylene glycol electrolyte lavage solution as compared with the standard solution for colonic cleansing. The difference in the salt concentrations of the two solutions could not regularly be distinguished by a group of healthy volunteers.

Effectiveness and Acceptability of Three Bowel Cleansing Regimens

The effectiveness and acceptability of three colon cleansing regimens for colonoscopy were compared in a prospective study in 271 patients stratified as in- and out-patients and randomly assigned to either I) a diet and Senna laxative (X-prep), combined with a saline enema (n = 88); II) 41 of a polyethylene glycol electrolyte lavage solution (Golytely) (n = 90); or III) a combined regimen of Cascara-Salax laxative (PicoSalax) and 1.51 Golytely (n = 93). Patients and colonoscopists indicated independently their overall impression of palatability and convenience and the completeness of the preparation, respectively, on 0- to 10-cm visual analogue scales. No differences were found between the regimens, either for the patients' impression of palatability or for the convenience of the preparation. A significantly cleaner colon was obtained with regimen II in outpatients than with regimen I (p = 0.02), whereas no differences were found either between regimens I and III or between regimens II and III. With regimen I, II, and III, 14%, 8%, and 12% of the patients, respectively, had scores indicating inadequate preparation. Outpatients (n = 175) had significantly cleaner colon than inpatients (n = 96) (p less than 0.001). In conclusion, no clinically important differences were found between the three bowel preparation regimens. An oral irrigation regimen is acceptable to the patients and may be preferable because it provides more flexibility to the endoscopic laboratory.

大腸内視鏡前処置におけるＰｏｌｙｅｔｈｙｌｅｎｅ Ｇｌｙｃｏｌ Ｅｌｅｃｔｒｏｌｙｔｅ Ｌａｖａｇｅ Ｓｏｌｕｔｉｏｎ（ＰＥＧ）服用方法の検討 服用量の減量について

患者の受容性を向上させるためPEGの服用量を2Lよりもさらに減量するための改良を試みた.すなわち,PEG併用法においてPEG服用開始後の排便回数が4回あった時点で服用を中止するという方法(PEG変法)をretrospective studyより設定し,100人の患者に本方法を行いPEG併用法を行った100人と比較検討した.その結果,服用量はPEG併用法の2000mlに対して1710±280ml(1000-2000m1)と有意(p<0.01)に減少し66%の症例で減量が可能であった.また排便回数はPEG併用法の7。9±2.7回(3-15回)に対して6.1±1.8回(3-10回)と有意(p<0.01)に少なく全例で10回以内に抑えられた.なお,両方法ともに清浄度,水分量については有意の差は認られなかった.以上より,PEG変法はPEGによる前処置をルーチン化するために適切な服用方法であると考えられた.

Theophylline Desorption From Activated Charcoal Caused By Whole Bowel Irrigation Solution1

Whole bowel irrigation with polyethylene glycol electrolyte lavage solution has been recommended as an adjunct to traditional overdose management. Although combined activated charcoal and whole bowel irrigation could enhance the efficacy of both modalities, this improvement remains largely speculative. An in vitro experiment was designed to determine whether polyethylene glycol electrolyte lavage solution alters the adsorption of theophylline to activated charcoal. Theophylline was agitated with activated charcoal in either water or polyethylene glycol electrolyte lavage solution, at each of three activated charcoal:theophylline ratios; 1:1, 3:1, and 10:1. The concentration in the supernatant was determined by high pressure liquid chromatography, and the maximal adsorptive capacity of activated charcoal for theophylline was calculated from the Langmuir equation. The percent of theophylline adsorbed by activated charcoal in water was 16 +/- 4%, 67 +/- 5%, and 97 +/- 3% for the 1:1, 3:1, and 10:1 ratios, respectively. This was decreased to 17 +/- 5%, 37 +/- 3%, and 62 +/- 2% when polyethylene glycol electrolyte lavage solution was added. A statistical difference (p less than 0.05) occurred at the 3:1 and 10:1 activated charcoal:theophylline ratios. Similarly the maximal adsorptive capacity was decreased 23% from 264 mg/g to 203 mg/g when polyethylene glycol electrolyte lavage solution was added to activated charcoal prior to theophylline. Polyethylene glycol electrolyte lavage solution significantly decreases adsorption of theophylline to activated charcoal in vitro. In vivo studies are required to confirm these findings. If activated charcoal is to be used clinically for theophylline toxicity, the authors suggest the possibility of larger quantities of activated charcoal, and administering activated charcoal in a slurry of water before the initiation of whole bowel irrigation.

経口的腸管洗浄剤の薬剤学的検討とその臨床応用

The powder and mixture for oral intestinal lavage solution (called Polyethylene glycol-electrolyte lavage solution: PEG-ELS) used for pre-treatment of endoscopy of the large intestine were prepared. The pH, buffer capacity, and viscosity were almost constant for maximum 21 days under three conditions (5°, 20°, and 30°).Any ingredients of powders and mixtures were almost stable for 21 days. Bacteria (S. aureus) proved to be hard to propagate in the mixture. The patients and physicians used the PEG-ELS evaluated the convenience, efficacy and easily of the mixture.

Whole bowel irrigation and the cocaine body-packer: A new approach to a common problem

Gastrointestinal drug smuggling is a common problem in many major cities. Though the majority of cases never require medical attention, the “body-packer” frequently presents with life-threatening symptoms of intoxication, including seizures and cardiorespiratory collapse, as well as mechanical obstruction from the ingested drug packets. The risk to asymptomatic smugglers may vary with packaging materials, and remains unknown. Lack of controlled studies, and varlations in packaging materials and clinical putcomes have prevented formulation of a consistent management strategy. Current recommendations for asymptomatic body-packers vary from immediate surgical removal, to use of laxatives, to observation. The authors present the first reported case of an asymptomatic cocaine body-packer treated with whole bowel irrigation with polyethylene glycol electrolyte lavage solution. This strategy was safe, well tolerated, resulted in the rapid elimination of drug packets from the gastrointestinal tract, and facilitated assessment by contrast radiography. The potential benefits and limitations for the use of whole bowel irrigation in this difficult problem are discussed.

Comparison of a new sulfate-free polyethylene glycol electrolyte lavage solution versus a standard solution for colonoscopy cleansing

A new sulfate-free polyethylene glycol electrolyte lavage solution (SF-ELS) for colonoscopy was formulated to taste better and have less net water and electrolyte secretion and absorption than a standard polyethylene glycolelectrolyte lavage solution (PEG-ELS). At two centers, 157 patients were prospectively randomized to receive SF-ELS or PEG-ELS to assess adequacy of preparation, patient tolerance, weight changes, and various hematologic and biochemical parameters. Physician assessment of colon cleansing showed no difference between those patients receiving SF-ELS (N = 74) or PEG-ELS (N = 78). Eighty-two percent of all preps were found to be "clinically acceptable." Subjects receiving SF-ELS had significantly less fullness and cramps, while PEG-ELS subjects reported less nausea. There was no difference between groups for vomiting, overall discomfort, or willingness to repeat the preparation received. Eighty percent of all patients would repeat the randomized cleansing methods. There were no clinically significant changes in weight or assessed laboratory parameters, with the exception of potassium where PEG-ELS patients had an mean decrease of 0.22 mEq/liter vs. 0.01 mEq/liter for SF-ELS (p less than or equal to 0.01). Patient taste questionnaires in those patients expressing a preference showed a preference for SF-ELS (76.6%) over PEG-ELS (23.4%) (p less than or equal to 0.001). Thirty-two (22.5%) of total respondents indicated no preference. We conclude that SF-ELS when compared with PEG-ELS is similarly a safe and effective method of colon cleansing for colonoscopy that is well tolerated. Patients prefer the taste of the new solution.

Effect of polyethylene glycol-electrolyte lavage solution on intestinal microflora.

The bacterial flora of colonic aspirates taken after oral administration of a polyethylene glycol-electrolyte lavage solution to patients undergoing colonoscopy was analyzed by standard bacteriological methods and DNA hybridization techniques. The data were compared with those for normal feces collected from the same patients the day before treatment. The results indicate that the bacterial composition of feces differs from individual to individual but is not altered by the oral intake of a polyethylene glycol-electrolyte lavage solution. This pilot study demonstrates that routine colonoscopy aspirates taken after standard colonoscopy preparation accurately reflect the microflora of feces and therefore may be used in large-scale epidemiological studies.

Whole bowel irrigation in pediatric patients: A comparison of irrigating solutions

The effect of whole bowel irrigation (WBI) with a polyethylene glycol electrolyte lavage solution (PEG-ELS; 27 children) was compared to the WBI with two electrolytic solutions: normal saline with added potassium chloride (NS; 25 children) and Ringer's injection (RI; 29 children). The PEG-ELS required less volume and time, and did not cause the weight gain, hemodilution, and hyperchloremia associated with use of the electrolytic solutions. A balanced PEG-ELS is preferred in WBI of children.

Whole bowel irrigation as a gastrointestinal decontamination procedure after acute poisoning.

Assuming a stable or stabilised patient, preventing the absorption of ingested toxins becomes a primary objective in the treatment of acute overdose. Traditional interventions aimed at achieving this end include ipecac-induced emesis, large bore orogastric lavage and activated charcoal administration (Cupit & Temple 1984; Easom & Lovejoy 1979). Whether any of these procedures benefits the patient remains unknown. Induced emesis and gastric lavage have especially been questioned (Comstock et al. 1981; Corby et al. 1968; Fane et al. 1971; Neuvonen et al. 1983; Tenenbein 1985a; Vale et al. 1986) and the literature seems to favour activated charcoal administration without a gastric emptying procedure (Chin 1972; Curtis et al. 1984; Fane et al. 1971; Kulig et al. 1985; Tenenbein et al. 1987a). However, the most common practice is to use one of the gastric emptying procedures, followed by activated charcoal. Apart from the concerns about their effectiveness, situations arise where all 3 of these interventions can be expected to be of limited benefit to the poisoned patient. These include the ingestion of a very large amount of a toxic substance (e.g. many times the lethal dose) , late presentation after the overdose, ingestion of delayed release pharmaceuticals and ingestion of substances not adsorbed by activated charcoal (particularly iron). In these situations whole bowel irrigation with polyethylene glycol electrolyte lavage solution offers promise as a method of treatment. The purpose of this article is to review relevant data and experience regarding this technique.