Polyethylene Glycol Electrolyte Solution Research Articles

Whole Bowel Irrigation should not be used routinely in poisoned patients.

Whole bowel irrigation is a method of gastric decontamination in the poisoned patient involving administration of large volumes of osmotically balanced polyethylene glycol-electrolyte solution to empty the gastrointestinal tract of ingested toxins before absorption, limiting systemic toxicity. While this approach may seem intuitive, and observational studies confirm it can lead to expulsion of tablets or packets in the rectal effluent, there is a lack of evidence correlating this with improved patient outcomes. Administration of whole bowel irrigation is also challenging to the inexperience physician and associated with adverse effects, which may be serious. Recommendations for the consideration of whole bowel irrigation are therefore limited to patients who have ingested modified release preparations, those of have ingested pharmaceuticals not adsorbed by activated charcoal, and for the removal of packages in body packers. Until more robust evidence is available from high-quality prospective studies demonstrating efficacy, the use of whole bowel irrigation should not be used routinely in poisoned patients.

Efficacy of morning-only dose compared with split-dose polyethylene glycol electrolyte solution in bowel cleansing for afternoon colonoscopy

Introduction: The efficacy of colonoscopy in detecting abnormalities within the colon is highly dependent on the adequacy of the bowel preparation. The objective of this study was to compare the efficacy and tolerability of morning only dose vs split-dose administration of polyethylene glycol (PEG) solution for colon cleansing in patients undergoing afternoon colonoscopy.
 Method: This was a comparative study conducted in Department of Medicine, Patan Academy of Health Sciences (PAHS), Patan Hospital, Nepal from November 2021 to June 2022. The ethical clearance was obtained from the Institutional Review Committee. Informed consent was taken from the patients. Patients aged >18 y undergoing elective colonoscopy were randomly assigned to one of the two bowel preparation regimens- morning only or split-dose of PEG. The adequacy of bowel preparation was assessed by the endoscopist using Boston Bowel Preparation scale. Preparation to colonoscopy (PC) interval, adverse events and risk factors for poor bowel preparations were noted.
 Result: In this study, 110 patients were included in the final analysis- 55 received morning only regimen and 55 received split-dose. Mean Boston bowel preparation scales of Morning only and Split-dose regimen were 7.60 and 7.09 respectively (p= 0.019). Split-dose group had significant sleep disturbances compared to Morning only regimen (p< 0.001), whereas nausea occurred significantly more often in Morning only regimen (p=0.012). Preparation to colonoscopy interval between 4-6 hours resulted in better bowel cleansing compared to PC interval of greater than 6 hours.
 Conclusion: Morning-only bowel preparation is more effective than Split-dose for achieving adequate colon cleansing for afternoon colonoscopy.

Efficacy of bowel preparation for colonoscopy with olive oil plus low volume polyethylene glycol-electrolyte lavage solution versus conventional volume polyethylene glycol-electrolyte lavage solution.

Objective: To compare the efficacy of bowel preparation with an olive oil plus low volume (2 liters) polyethylene glycol-electrolyte lavage solution (PEG-ELS) and conventional volume (4 liters) PEG-ELS solution. Study Design: Randomized, Controlled Trial. Setting: Lahore General Hospital. Period: September 2017 and November 2018. Material & Methods: Patients were randomly assigned to two groups. Group A patients were given olive oil plus low volume (2 liters) PEG-ELS and Group B patients were given conventional volume (4 liters) PEG-ELS solution. Achievement of the adequate preparation was assessed using the Boston Bowel Preparation Scale (BBPS). A questionnaire was used in assessing the ease or difficulty of ingesting the bowel-cleansing preparation. All analysis was conducted with SPSS 20.0. Results: Of the total 162 patients randomized, 24 were excluded due to various reasons. Of 138 studied patients, mean age was 40.88 ± 13.75 years, 90 (65.21%) were male and 48 (34.78%) were female. Overall, 42 (30.4%) patients had Boston Bowel Preparation Score (BBPS) 8 and 9 indicating excellent bowel preparation, 38 (27.5%) had good bowel preparation with score 6 and 7, 30 (21.7%) patients had poor bowel preparation with score 3-5, and 28 (20.3%) patients had inadequate bowel preparation with score 0-2. The mean BBPS was 6.11 ± 2.6 with the olive oil preparation and 4.63 ± 2.81 with conventional PEG-ELS preparation (P = <0.005). More patients in Olive Oil group had excellent bowel preparation as compared to conventional group (43% versus 15%, p <0.005). The mean time of examination was 23.2 minutes in Group A and 21.85 in Group B (P <0.05). Mean time for colonoscopy was much higher (28.75 min.) in patients with a BBPS score of < 3. 61%of patients in Olive Oil group experienced no side effects as compared to 43% in the conventional PEG-ELS group (p < 0.05). Abdominal pain was the most common side effect observed, more frequent in the conventional PEG-ELS group (30% versus 4.9%, p<0.05). Conclusion: Low volume PEG plus olive oil is a valid alternative and more applicable to bowel preparation for colonoscopy than conventional volume PEG, with superior efficacy, better compliance and tolerability and better safety profile.

Comparative Study of Single- Versus Split-Dose Polyethylene Glycol Electrolyte Solution Before Undergoing Colonoscopy

Objective: To compare the outcome of consumption of a single versus split-dose polyethylene glycol electrolyte solution in patients undergoing colonoscopy in the morning. Methodology: A randomised controlled trial was conducted at the Department of Gastroenterology, Sir Ganga Ram Hospital, Lahore, from April to July 2021. A total of 274 patients undergoing colonoscopy, who fulfilled the selection criteria were included through a "non-probability, consecutive sampling technique". The patients were randomly divided into two groups. In group A, single dose of PEG was administered. Group B was administered a split dose of PEG which was to be consumed in two parts, 1st in evening before colonoscopy and the second in the morning. Efficacy was labelled if adequate cleaning of the intestines and a BBPS score of ≥6 were achieved during colonoscopy. Results:  In the single dose group, the mean age of patients was 45.15 ± 13.37 years, 68 (49.6%) patients were male, 69 (50.4%) patients were female, efficacy of the procedure was achieved in 54 (39.4%) patients, and the mean BBPS score was 4.99 ± 0.90. In the split dose group, mean age of patients was 49.85 ± 11.38 years, 56 (40.9%) patients were male, 81 (59.1%) patients were female, efficacy of the procedure was achieved in 137 (100%) patients, and the mean BBPS score was 7.61 ± 0.49. The difference in both groups was highly significant (p-value < 0.0001). Conclusion: A split dose is thus more efficacious and acceptable than a single dose of polyethylene glycol electrolyte solution given for bowel preparation.

A Randomized Study Comparison between Split Dosage and Non-Split Dosage PEG-Electrolyte Solution Preparation Methods for Elective Colonoscopy

Background: A two liters low volume polyethylene glycol (PEG) electrolyte solution preparation was proposed for improving patients’ tolerability with either split or non-split dosage cleansing method. Patient compliance, adverse experiences, and cleansing efficacy of each anatomical segment of the colon using both methods should be determined. Objective: To assess the cleansing efficacy of split dosage versus non-split dosage PEG-electrolyte solution for each anatomical segment of the colon according to the inverted Ottawa bowel preparation scale. Materials and Methods: The present study was a prospective, randomized, endoscopist-blinded study. Volunteers that underwent elective screening colonoscopy were eligible for recruitment into the present study. Patients having any contraindication for colonoscopy, or the use of PEG-electrolyte solution such as bowel obstruction, intestinal perforation, or toxic megacolon were excluded. Cleansing efficacy was evaluated by the inverted Ottawa bowel preparation scale for each anatomical segment of the colon. Medical adherence and compliance were evaluated. Participants were asked to rate their satisfaction and inform the presence of any adverse experiences related to the bowel preparation method. Results: Ninety-four volunteers were randomly assigned to two groups. Of these, 46 received the split dosage cleansing method and 48 received the non-split dosages cleansing method. Overall compliance was approximately 94%, comparable for both preparation methods. Average age was 61.5 years for non-split dosage and 60.4 for split dosage group. Satisfaction score in the non-split dosage group was 8.46, which was not significantly different from 8.56 of the split dosage group (p=0.934). Split dosage PEG-electrolyte solution provided comparable degree of cleansing as standard non-split dosages preparation for transverse, descending, sigmoid, and rectum. However, split dosage provided significantly superior cleansing results over the non-split dosages method for ascending colon at good or excellent with 84.7% versus 47.9% (p<0.01), and caecum at good or excellent for 76.1% versus 41.7% (p<0.01) based on the inverted Ottawa bowel preparation scale. Conclusion: Split dosage PEG-electrolyte solution method provided significantly superior cleansing results over the non-split dosages method for right-side colon with comparable satisfaction score and rate of adverse events. Keywords: Bowel preparation; Split dosage cleansing; Quality of bowel preparation

Comparative Effectiveness and Safety of Polyethylene Glycol Electrolyte Solution Versus Lactulose for Treatment of Hepatic Encephalopathy: A Systematic Review and Meta-analysis.

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome associated with liver failure and/or portal systemic shunting. Polyethylene glycol (PEG) electrolyte solution is a commonly used for catharsis of gut, which has been demonstrated to relieve HE in a number of randomized controlled trials. The aim of this paper was to evaluate the comparative efficacy and safety of PEG with lactulose for current HE treatment. PEG electrolyte solution versus lactulose of HE was deeply studied by conducting a systematic search in electronic databases and other sources until December 31, 2020. The PRISMA statement recommended the use of meta-analysis with 95% confidence interval (CI), relative risk (RR), and weighted mean deviation (WMD) as the estimated effect size. A sensitivity analysis was performed comprehensively to present the risk of bias and the source of heterogeneity. A total of 434 patients were involved in 7 randomized studies. It is found that there was a significant advantage of PEG therapy in the increase of clinical efficacy (RR=1.46; 95% CI: 1.26-1.68; P=0.000; I2=0.0%) and the decrease of hospital stay (WMD=-1.78; 95% CI: -2.72 to 0.85; P=0.000; I2=90.1%). There was no significant difference in the incidence of adverse events (RR=0.75; 95% CI: 0.48-1.19; P=0.222>0.05; I2=7.2%) and the level of serum ammonia (WMD=9.02; 95% CI: -14.39 to 32.43; P=0.45>0.05; I2=84.9%) after 24 hours between the 2 groups. The results prove that PEG has a beneficial effect on the treatment of HE. Compared with lactulose, PEG can lead to more rapid HE resolution during the first 24 hours and shorten the length of stay without increasing the rate of adverse effects.

Ischemic Colitis Caused by Bowel Preparation for Colonoscopy.

BackgroundIschemic colitis is an adverse event which may occur during bowel preparation for colonoscopy. This study aims to clarify both the incidence and the risk factors of this complication.MethodsThis was a single-center, retrospective, observational study. All outpatients who were prescribed standardized preparation drugs for colonoscopy at the Kyoto Second Red Cross Hospital between November 2011 and March 2020 were included in the study. A split bowel preparation was carried out as follows; magnesium citrate with or without sodium picosulfate hydrate was/were used as a preparation drug on the day before the colonoscopy, and polyethylene glycol electrolyte solution or sodium phosphate was used on the morning of the endoscopic procedure. Patients were extracted from the electronic medical records and matched with the endoscopy database by examination date and hospital identification number. Following the endoscopic findings, both the incidence and risk factors for ischemic colitis arising after bowel preparation were examined.ResultsAmong the 14,924 patients analyzed, ischemic colitis was observed in 14 patients (0.09%). Multivariate analysis revealed that old age (≥ 75 years old) and strong preparation (magnesium citrate with sodium picosulfate and polyethylene glycol electrolyte solution) for constipated patients were independent risk factors for ischemic colitis (odds ratio: 3.64 (95% confidence interval (CI): 1.36 - 9.77) and 4.27 (95% CI: 1.45 - 12.53), respectively).ConclusionsThe age 75 years and above and strong preparation for patients with constipation were independent risk factors for ischemic colitis prior to colonoscopy. Careful attention should be paid to bowel preparation before colonoscopy for patients aged ≥ 75 years and for those with constipation.

A134 A MULTI-CENTRE RANDOMIZED CONTROLLED TRIAL TO COMPARE TWO BOWEL CLEANSING REGIMENS AFTER A COLONOSCOPY WITH INADEQUATE BOWEL PREPARATION

Abstract Aims Failed bowel preparation is common during colonoscopy, yet the optimal purgative regimen to use for the next attempt is unknown. The objective of this study was to compare the efficacy, tolerability, and safety of two regimens at supratherapeutic doses for use after failed bowel preparation. Methods A multi-centre phase III endoscopist blinded randomized controlled trial (NCT02976805) was conducted in patients who failed bowel preparation, using the US Multi-Society Task Force (USMSTF) definition of inability to exclude polyps >5 mm in size and requiring a shortened interval to next colonoscopy. Regimen A consisted of 15 mg of bisacodyl and 2 + 2 L of split dose polyethylene glycol electrolyte solution (PEG) and Regimen B consisted of 15 mg of bisacodyl and 4 + 2 L of split dose PEG. The primary outcome was adequate bowel preparation, defined as a Boston Bowel Preparation Scale (BBPS) total score ≥ 6 with all segment scores ≥ 2. Secondary outcomes were adequate bowel preparation using the USMSTF definition, median BBPS, adenoma detection (ADR), advanced adenoma detection (aADR), sessile serrated polyp detection (SSPDR), and cecal intubation (CIR). Adverse events were assessed at the time of the colonoscopy and 14 days later. Results Between February 2017 and December 2019, 250 subjects were screened at four academic centres in Canada, of which 195 were randomized: 96 to Regimen A and 99 to Regimen B. The mean (SD) age was 60.6 (11.4) years, 87 (45.1%) were female, and the median (IQR) total BBPS score at previous failed colonoscopy was 3 (1,4). Regimen B was not superior to Regimen A in achieving adequate bowel preparation using the BBPS definition (87.6% vs. 91.1%, p=0.45) or the USMSTF definition (85.4% vs 91.1%, p=0.24), nor was it superior with respect to the median BBPS score (7 vs 7, p=0.50), mean ADR (31.5% vs 37.8%, p=0.37), aADR (11.2% vs 18.9%, p=0.15), SSPDR (5.6% vs 8.9%, p=0.40) or CIR (92.1% vs 96.7%, p=0.19). Regimen A had a higher adherence rate (88.2% vs. 74.7%, p=0.02) and greater willingness to undergo the bowel preparation again (91.2% vs. 66.2%, p<0.001). The only serious adverse event occurred in a patient randomized to Regimen B who was admitted to hospital for vomiting after colonoscopy. Conclusions Split dose 4L PEG with 15mg of bisacodyl is highly efficacious, well tolerated, and can be used for patients who previously failed first line bowel preparations. The additional 2L of PEG in Regimen B did not improve bowel preparation and was not as well tolerated. Funding Agencies AMOSO Opportunities Grant, Pharmascence Inc.

A patient-centered framework for health systems engineering in gastroenterology: improving inpatient colonoscopy bowel preparation

BackgroundInpatient colonoscopy bowel preparation (ICBP) is frequently inadequate and can lead to adverse events, delayed or repeated procedures, and negative patient outcomes. Guidelines to overcome the complex factors in this setting are not well established. Our aims were to use health systems engineering principles to comprehensively evaluate the ICBP process, create an ICBP protocol, increase adequate ICBP, and decrease length of stay. Our goal was to provide adaptable tools for other institutions and procedural specialties.MethodsPatients admitted to our tertiary care academic hospital that underwent inpatient colonoscopy between July 3, 2017 to June 8, 2018 were included. Our multi-disciplinary team created a protocol employing health systems engineering techniques (i.e., process mapping, cause-effect diagrams, and plan-do-study-act cycles). We collected demographic and colonoscopy data. Our outcome measures were adequate preparation and length of stay. We compared pre-intervention (120 ICBP) vs. post-intervention (129 ICBP) outcomes using generalized linear regression models. Our new ICBP protocol included: split-dose 6-L polyethylene glycol-electrolyte solution, a gastroenterology electronic note template, and an education plan for patients, nurses, and physicians.ResultsThe percent of adequate ICBPs significantly increased with the intervention from 61% pre-intervention to 74% post-intervention (adjusted odds ratio of 1.87, p value = 0.023). The median length of stay decreased by approximately 25%, from 4 days pre-intervention to 3 days post-intervention (p value = 0.11).ConclusionsBy addressing issues at patient, provider, and system levels with health systems engineering principles, we addressed patient safety and quality of care provided by improving rates of adequate ICBP.

A Comparative Clinical Study of a Novel Pre-colonoscopy Bowel Capsule Preparation Against Two Commercially Available Liquid Preparations.

Background and Aims: Colonoscopy surveillance depends on effective bowel preparation. Inadequate bowel preparation can lead to inaccurate clinical diagnosis, insufficient visualization of the colon and increased risk of missed diagnosis. This study aimed to compare the efficacy and safety of a novel Capsule Bowel Preparation (RitePrep), high-volume (2L) polyethylene glycol electrolyte solution (MoviPrep®) and low-volume (1L) polyethylene glycol electrolyte solution (Plenvu™).Methods: Patients (n = 120) were divided into three groups and were administered either RitePrep, MoviPrep® or Plenvu™ as a pre-colonoscopy bowel preparation followed by a colonoscopy at a single center. Validated Boston Bowel Preparation Score (BBPS) and bubble score were used to evaluate bowel cleanliness. Blood tests were also evaluated. The scores and the blood results were analyzed using Kruskal-Wallis and Chi-squared tests.Results: A total of 120 patients (median age of 55; 57 males) [RitePrep (n = 40), MoviPrep® (n = 40) and Plenvu™ (n = 40)] were included in the study. RitePrep was the most effective method for cleansing the bowel, with a significantly higher median BBPS compared to MoviPrep® and Plenvu™ (p = 0.006 and 0.024, respectively). Nearly 50% of the patients in Plenvu™ group showed increased serum osmolality disturbance. Nausea and vomiting were higher in Plenvu™ and MoviPrep® groups than RitePrep group.Conclusions: RitePrep was demonstrated to be a more effective and safe preparation than the other two preparations. RitePrep was not only well-tolerated by all patients; the preparation sufficiently cleared the ascending, transverse, and descending colon, enabling optimal visualization for the clinician. RitePrep was also much safer than the comparators, with no alteration in electrolytes measured. For both the clinician and the patient, RitePrep was the preferred preparation.

Randomized clinical trial: efficacy and tolerability of two different split dose of low-volume polyethylene glycol electrolytes for bowel preparation before colonoscopy in hospitalized children.

Eighty milliliter per kilogram of polyethylene glycol (PEG) for bowel preparation (BP) has been recommended, but the amount of liquid orally without nasogastric intubation is difficult to achieve. This study is to compare the efficacy and tolerability of two different low-volume PEG electrolyte solutions for BP in children. The randomized, double-blind, controlled trial enrolled 150 children aged 6-18 years undergoing colonoscopy in our center. Patients were randomly assigned to receive 60 ml/kg (PEG-ELS 60) or 40 ml/kg (PEG-ELS 40) of PEG electrolytes (PEG-ELS) 4000. The Boston Bowel Preparation Scale was used for bowel cleansing evaluation. Primary end point was overall colon cleansing. Tolerability was also evaluated. PEG-ELS 40 and PEG-ELS 60 had similar efficacy in bowel cleansing for both whole colon and various colonic segments. The proportions of patients experiencing any adverse symptoms, or those who were willing to have BP repeated if necessary were similar in both groups. More patients considered the BP solution easy to take and be satisfied with the preparation in PEG-ELS 40 than PEG-ELS 60. Low volume of PEG-ELS for BP has good efficacy in bowel cleansing. PEG-ELS with 40 ml/kg volume was not inferior to that of 60 ml/kg. PEG-ELS 40 and PEG-ELS 60 had similar efficacy in bowel cleansing for whole and various colonic segments. The proportions of patients experiencing any adverse symptoms, or those who were willing to have BP repeated if necessary were similar in both groups. More patients considered BP solution easy to take and be satisfied with the preparation in PEG-ELS 40 than PEG-ELS 60. This study showed that low-volume PEG-ELS monotherapy was effective in bowel cleansing and explored a possibly feasible BP method for pediatrics in China that PEG-ELS 40 was comparable to PEG-ELS 60 regimen.

The advantage of polyethylene glycol electrolyte solution combined with lactulose in patients with long interval preparation-to-colonoscopy.

The main aim of the present study was to assess the efficacy of polyethylene glycol electrolyte (PEG) solution combined with lactulose in bowel preparation to find a new method for colonoscopy preparation to improve the quality of colonoscopy in patients with long interval preparation-to-colonoscopy (P-C). A prospective, randomized, endoscopist-blinded and placebo-controlled study was conducted. Three hundred sixty patients who were scheduled for colonoscopy were enrolled in the study. They were randomly divided into the PEG-lactulose group and the PEG-placebo group with 180 patients per arm. Two of the most common methods for estimating the quality of bowel preparation were the use of the Boston Bowel Preparation Scale and the measurement of the Bubble Scale and adenoma detection rate (ADR) as a secondary outcome of observation. The PEG-lactulose group had a significant improvement in the quality of bowel preparation compared with the PEG-placebo group including colon cleanliness in interval P-C at 8 and 9 h (p<0.05) and bubble elimination in interval P-C at 5, 6, 7, 8, and 9 h (p<0.05). Compared with the PEG-placebo group, the ADR (23.3% vs. 15.0%, p<0.05) and the size (≤5 mm) of the adenoma (45.2% vs. 18.5%, p<0.05) increased in the PEG-lactulose group, and there were significant differences between the two groups. PEG solution combined with lactulose can improve the quality of colonoscopy in patients with long interval P-C to allow the patients to select more flexible colonoscopy time. It is worth further popularizing in clinical practice.

Efficacy of single- versus split-dose polyethylene glycol electrolyte solution for morning colonoscopy: A randomized controlled study.

Background:Split-dose (SPD) regimen has been proved more effective than a single-dose (SID) regimen for various drug preparations; however, limited data have focused on morning colonoscopy. We implemented this study to compare the bowel cleanliness and tolerability of a same-day SID versus SPD 2 L polyethylene glycol electrolyte solution (PEG) for morning colonoscopy.Methods:Patients undergoing morning colonoscopy were randomized into two groups, SID or SPD. In the SID group, patients had to complete 2 L PEG between 4 and 6 am on the day of colonoscopy. In the SPD group, patients had to complete 1 L PEG between 8 and 9 pm on the day before followed by another 1 L PEG between 5 and 6 am on the day of colonoscopy. Colonoscopy was performed between 8 and 12 am under anesthesia. Investigators and endoscopists were blinded to the allocation. The primary end point was the effectiveness of bowel cleansing according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes were polyp detection rate, compliance, tolerability, and patient satisfaction.Results:Overall, there were 147 and 148 patients in the SID and SPD group, respectively. The SPD group had a better quality of bowel preparation than the SID group with a total BBPS score of 7.25 ± 1.53 versus 6.71 ± 1.65 (P = 0.005). No difference in the polyp detection rate was noted, although more polyps were detected in the SPD group. More patients felt acceptable with the bowel preparation regimen in the SPD group compared to the SID group (76% vs. 65%, P = 0.03). The adverse events were more commonly observed in the SID group, presented as nausea and vomiting.Conclusion:For morning colonoscopy, split-dose 2 L PEG is superior to single-dose 2 L PEG by improved bowel preparation, better tolerability, and patient satisfaction.

Multicentre endoscopist-blinded randomised clinical trial to compare two bowel preparations after a colonoscopy with inadequate cleansing: a study protocol

IntroductionInadequate bowel preparation is common and negatively impacts colonoscopy quality. The objective of this study is to compare two bowel preparation regimens in cleansing the colon after an index colonoscopy...

Bowel preparation for small bowel capsule endoscopy – The later, the better!

BackgroundIn small bowel capsule endoscopy (SBCE), the presence of residue may compromise diagnostic accuracy. AimsTo assess differences in quality of visualisation and diagnostic yield of SBCE using 3 different preparation protocols. MethodsProspective, randomized, blind, pilot study. Protocol A:Clear liquids diet the day before the examination with fasting from 8p.m.; Protocol B:Protocol A + 2 pouches of Moviprep®(polyethylene glycol electrolyte solution + sodium ascorbate) in 1 L of water from 8p.m. of the day before the examination; Protocol C: Protocol A + 2 pouches of Moviprep® in 1 L of water consumed after real-time confirmation of capsule arrival at small bowel.Small bowel preparation was classified by two experienced physicians, considering the percentage of the examination during which mucosal observation was adequate: Excellent(>90%); Good(90–75%); Fair(75–50%); Poor(<50%). Results101 patients randomized to the 3 protocols (A 37, B 31, C 33 patients). Protocol C had an excellent/good small bowel preparation in a higher percentage of examinations for both readers(Reader 1-A:37.8% vs B:45.2% vs C:78.8%, p = 0.002 and Reader 2 –A:37.8% vs B:41.9% vs C:75.8%, p = 0.003). Also, protocol C had a higher detection of angioectasia (A:5.4% vs B:9.7% vs C:27.3%, p = 0.022). ConclusionsThe administration of Moviprep® after the capsule had reached the small bowel was associated with a better small bowel preparation and a higher detection of angioectasia.

Mo1628 – Prospective Pre-Colonoscopy Bowel Preparation Study Comparing Novel Capsule Bowel Preparation (CBP) Vs High Volume Polyethylene Glycol Electrolyte Solution Vs Low Volume Polyethylene Glycol Electrolyte Solution

Mo1628 – Prospective Pre-Colonoscopy Bowel Preparation Study Comparing Novel Capsule Bowel Preparation (CBP) Vs High Volume Polyethylene Glycol Electrolyte Solution Vs Low Volume Polyethylene Glycol Electrolyte Solution

Computed Tomography Enterography: Better Luminal Distension with a Shorter Ingestion Time Protocol in an Indian Population

Abstract Aim This article prospectively evaluates the adequacy of bowel distension in computed tomography enterography (CTE) with a 45-minute contrast ingestion time and compares it with the most widely used protocol in the literature of 1 hour 20 minutes. Materials and Methods The CTE was performed in 42 consecutive patients divided into two groups—A and B. Group A patients were instructed to drink 2 L of polyethylene glycol electrolyte solution over 1 hour 20 minutes. Group B patients were instructed to do the same over 45 minutes. At the end of contrast ingestion, plain and contrast CT abdomen was performed and CTE images were reviewed. Manual quantitative analysis of degree of small bowel distension was performed in the following manner: on coronal images, the abdominal cavity was divided into four quadrants: right upper, left upper, right lower, and left lower quadrants. The maximum small bowel lumen diameter (inner-to-inner wall) was measured in five different loops within each of the four quadrants. If four or more measurements in a quadrant ≥ 1.8 cm (considered “adequate luminal distension”), a score of 1 was assigned to that quadrant. If less than 4 measurements in the quadrant &gt; 1.8 cm, a score of 0 was assigned to that quadrant. The ensuing sum of scores from all four quadrants resulted in the distension grade for that CTE study (Grades 1–4). Results There was a statistically significant difference in the degree of small bowel distension between the two groups with better distension seen in group B (p &lt; 0.001). Conclusion Indians have a rapid gut transit time compared with Western populations. Hence, CTE contrast ingestion time protocols optimized in Western populations may not be suitable in Indians. The shorter 45-minute ingestion protocol provided consistently better luminal distension in our population than the longer 1 hour 20-minute protocol described in the literature. To the best of our knowledge, there are no other studies comparing CTE ingestion time protocols in a given population.

Polyethylene Glycol Electrolyte Solution: Safety Considerations in Atopic Patients

Polyethylene Glycol Electrolyte Solution: Safety Considerations in Atopic Patients

Crown of Thorns: A Case of Dental Crown Ingestion During Cardiothoracic Surgery

Dental trauma is a well-known complication during anesthesia in operating rooms. However, ingestion of teeth or other foreign body after trauma from anesthesia is less common. Although most ingested foreign bodies pass through the digestive tract spontaneously, foreign body ingestion can be associated with significant complications including bowel perforation, obstruction, respiratory compromise and abscess formation, among others. We report a case of a 69-year-old female with a history of obstructive lung disease and diverticulosis who presented with shortness of breath. She was found to have a spontaneous left pneumothorax treated with pigtail catheter insertion in the emergency department resulting in partial re-expansion of her lung. After failed chemical pleurodesis with bleomycin, she underwent left-sided talc pleurodesis via thoracoscopy in the OR. After evaluation by the anesthesiologist in PACU, she was noted to be missing dental construct with evidence of a clean break from dental injury. A chest x-ray and upright abdominal film were ordered which revealed the dental hardware located in right upper quadrant of the abdomen. A CT of the abdomen revealed the foreign body to be present in a loop of small bowel 15 cm from the ileocecal valve. Gastroenterology was consulted for evaluation and recommended serial x-rays as the foreign body had been progressing. Because of the location, endoscopic removal was not possible. Nonoperative management was attempted with aggressive bowel regimen to aid the progression of the ingested foreign body. The patient received senna, polyethylene glycol, and magnesium citrate over the course of four days. Finally, she was given 4 liter of polyethylene glycol electrolyte solution without successful passage of the foreign body after several bowel movements. A repeat CT abdomen did not demonstrate significant progression past the ileocecal valve. As a result, the patient was taken to the OR for surgical removal via exploratory laparotomy. This case demonstrates the importance of complete assessment of dental prosthetics and hardware prior to anesthesia interventions to prevent serious complications from foreign body ingestion.

Acute Myocardial Infarction Following Administration of Polyethylene Glycol Electrolyte Solution with Ascorbic Acid (MoviPrep®) at Home: A Case Report.

A male individual aged 82 years with hypertension who had a smoking history, but no history of cardiovascular events, developed acute myocardial infarction immediately after he took oral polyethylene glycol electrolyte solution with ascorbic acid as a pretreatment for a colonoscopy to examine anemia. He took polyethylene glycol electrolyte solution with ascorbic acid at twice (2 L/h) the rate recommended in the package insert and by the physician. The patient showed impaired consciousness 2 h after taking polyethylene glycol electrolyte solution with ascorbic acid and his family called the emergency medical service. Upon arrival of the emergency medical service, his systolic blood pressure was 60 mmHg and heart rate was 50 bpm. Systolic blood pressure and impaired consciousness were slightly improved, but compensatory shock remained, at arrival at the emergency outpatient service at our hospital. No dyspnea or rash was apparent. The patient had no subjective chest pain; however, ST-segment elevation was detected in the electrocardiogram at II, III, aVF, V3R, and V4R. He was diagnosed with ST-segment elevation myocardial infarction and underwent a coronary catheter intervention for total occlusion of the right coronary artery. His shock state was abolished by this intervention. The patient was pretreated with polyethylene glycol electrolyte solution with ascorbic acid under close watch in the coronary care unit 4 days later, with no relapse of symptoms. Advanced cancer was found in the ileocecum by colonoscopy; consequently, the patient underwent a colectomy and was discharged from our hospital and transferred to another hospital for rehabilitation on hospital day 74. A Naranjo assessment score of 4 was obtained, indicating a possible relationship of acute myocardial infarction with misuse of the suspect drug, polyethylene glycol electrolyte solution with ascorbic acid.