Research Progress of Bowel Preparation for Colonoscopy

Colorectal cancer ranks third in the global cancer data in 2020. Colorectal scope is the most effective method to diagnose colorectal diseases such as benign and malignant colorectal tumors. The poor quality of intestinal preparation causes an increased rate of missed diagnosis of colorectal tumors, reduces the rate of cecal intubation for colorectal examination, increases the discomfort, and reduces the compliance of re-examination. Therefore, we should try our best to improve the quality of intestinal preparation. This study reviewed the latest advances related to the preoperative preparation for colonoscopy. Recent research shows that smartphone apps can provide more detailed education and guidance on bowel preparation;Pre-packaged foods are more suitable as a way to eat before colonoscopy. The use of smaller doses, better taste of cathartic agents, and some auxiliary measures, combined with the patient’s situation to provide personalized intestinal preparation measures to improve the quality of intestinal preparation. Starting from the quality of colonoscopy bowel preparation, continuous improvement of patients’ tolerance to bowel preparation, continuous improvement of bowel preparation plan based on individual factors’ needs, and better communication with examined subjects by using existing scientific information technology, may be the hot spot of colonoscopy bowel preparation research in the next few years.

Bowel preparation experiences and needs before follow-up colonoscopy in older adult postoperative colorectal cancer patients: A qualitative study

BACKGROUND The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation,which in turn affects the quality of the colonoscopy.Colono-scopy is an essential procedure for postoperative follow-up monitoring of colorec-tal cancer(CRC)patients.Previous studies have shown that advanced age and a history of colorectal resection are both risk factors for inadequate bowel prepara-tion.However,little attention has been paid to the bowel preparation experiences and needs of predominantly older adult postoperative CRC patients.AIM To explore the experiences and needs of older adult postoperative CRC patients during bowel preparation for follow-up colonoscopy.METHODS Fifteen older adult postoperative CRC patients who underwent follow-up colonoscopy at a tertiary hospital in Shanghai were selected using purposive sampling from August 2023 to November 2023.The phenomenological method in qualitative research was employed to construct an interview outline and conduct semi-structured interviews with the patients.Colaizzi's seven-step analysis was utilized to organize,code,categorize,summarize,and verify the interview data.RESULTS The results of this study were summarized into four themes and eight sub-themes:(1)Inadequate knowledge about bowel preparation;(2)Decreased physiological comfort during bowel preparation(gastrointestinal discomfort and sleep deprivation caused by bowel cleansing agents,and hunger caused by dietary restrictions);(3)Psychological changes during different stages of bowel preparation(pre-preparation:Fear and resistance due to previous experiences;during preparation:Irritation and helplessness caused by taking bowel cleansing agents,and post-preparation:Anxiety and worry while waiting for the colonoscopy);and(4)Needs related to bowel preparation(detailed instructions from healthcare professionals;more ideal bowel cleansing agents;and shortened waiting times for colonoscopy).CONCLUSION Older adult postoperative CRC patients'knowledge of bowel preparation is not adequate,and they may encounter numerous difficulties and challenges during the process.Healthcare professionals should place great emphasis on providing instruction for their bowel preparation.

Evaluating bacterial contamination and surgical site infection risks in intracorporeal anastomosis: Role of bowel preparation

We recently read the study by Kayano et al on intracorporeal anastomosis(IA)for colon cancer,which assessed bacterial contamination and medium-term onco-logical outcomes and affirmed that IA is analogous to extracorporeal anastomosis in reducing intraperitoneal bacterial risk and achieving similar oncological results.Our commentary addresses gaps,particularly concerning bowel preparation and surgical site infections(SSIs),and highlights the need for comprehensive details on the bowel preparation methods that are currently employed,including mecha-nical bowel preparation,oral antibiotics(OA),their combination,and specific OA types.We emphasize the necessity for further analyses that investigate these me-thods and their correlation with SSI rates,to enhance clinical protocol guidance and optimize surgical outcomes.Such meticulous analyses are essential for refi-ning strategies to effectively mitigate SSI risk in colorectal surgeries.

Research Progress of Bowel Preparation for Colonoscopy

Colorectal cancer ranks third in the global cancer data in 2020.Colorectal scope is the most effective method to diagnose colorectal diseases such as benign and malignant colorectal tumors.The poor quality of intestinal preparation causes an increased rate of missed diagnosis of colorectal tumors,reduces the rate of cecal intubation for colorectal examination,increases the discomfort,and reduces the compliance of re-examination.Therefore,we should try our best to improve the quality of intestinal preparation.This study reviewed the latest advances related to the preoperative preparation for colonoscopy.Recent research shows that smartphone apps can provide more detailed education and guidance on bowel preparation;Pre-packaged foods are more suitable as a way to eat before colonoscopy.The use of smaller doses,better taste of cathartic agents,and some auxiliary measures,combined with the patient’s situation to provide personalized intestinal preparation measures to improve the quality of intestinal preparation.Starting from the quality of colonoscopy bowel preparation,continuous improvement of patients’tolerance to bowel preparation,continuous improvement of bowel preparation plan based on individual factors’needs,and better communication with examined subjects by using existing scientific information technology,may be the hot spot of colonoscopy bowel preparation research in the next few years.

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients:Evidence from the literature

Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection.Nevertheless,almost a quarter of procedures are still carried out with suboptimal preparation,resulting in longer procedure times,higher risk of complications,and higher likelihood of missing lesions.Current guidelines recommend high-volume or low-volume polyethylene glycol(PEG)/non-PEG-based split-dose regimens.In patients who have had insufficient bowel cleansing,the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option.A strategy that includes a prolonged low-fiber diet,a split preparation regimen,and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly.Furthermore,even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients,clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients.Patients with severe renal insufficiency(creatinine clearance<30 mL/min)should be prepared with isotonic high volume PEG solutions.Few data on cirrhotic patients are currently available,and no trials have been conducted in this population.An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation,especially in patients undergoing resection of left colon lesions,where intestinal preparation has a poor outcome.The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients,as well as strategies to improve colonoscopy preparation in these patients.

Emerging space for non-polyethene-glycol bowel preparations in inflammatory bowel disease-related colonoscopy:Veering toward better adherence and palatability

Patients with inflammatory bowel diseases(IBDs)require repeated endoscopic evaluations over time by colonoscopy to weigh disease activity but also for different and additional indications(e.g.,evaluation of postoperative recurrence,colorectal cancer surveillance).Colonoscopy,however,requires adequate bowel preparation to be of quality.The latter is achieved as long as the patient takes a certain amount of product to have a number of bowel movements suitable to clean the colon and allow optimal visualization of the mucosa during endoscopy.However,significant guidelines recommend preparations for patients with IBD not excelling in palatability.This recommendation originates from the fact that most of the studies conducted on bowel preparations in patients with IBD have been done with isosmolar preparations based on polyethylene glycol(PEG),for which,therefore,more safety data exist.As a result,the low-volume non-PEG preparations(e.g.,magnesium citrate plus picosulphate,oral sulphate solutions)have been set aside for the whole range of warnings to be heeded because of their hyperosmolarity.New studies,however,are emerging,leaning in overall for a paradigm shift in this matter.Indeed,such non-PEG preparations seem to show a particularly encouraging and engaging safety profile when considering their broad potential for tolerability and patient preference.Indeed,such evidence is insufficient to indicate such preparations in all patients with IBD but may pave the way for those with remission or well-controlled disease.This article summarizes the central studies conducted in IBD settings using non-PEG preparations by discussing their results.

Quality of bowel preparation in patients with inflammatory bowel disease undergoing colonoscopy:What factors to consider?

An adequate bowel preparation in patients with inflammatory bowel disease(IBD)is a prerequisite for successful colonoscopy for screening,diagnosis,and surveillance.Several bowel preparation formulations are available,both high-and low-volume based on polyethylene glycol.Generally,low-volume formulations are also based on several compounds such as magnesium citrate preparations with sodium picosulphate,oral sulphate solution,and oral sodium phosphatebased solutions.Targeted studies on the quality of bowel preparation prior to colonoscopy in the IBD population are still required,with current evidence from existing studies being inconclusive.New frontiers are also moving towards the use of alternatives to anterograde ones,using preparations based on retrograde colonic lavage.

Anaphylactic shock induced by polyethylene glycol after bowel preparation for the colorectal cancer surgery:A case report

BACKGROUND Polyethylene glycol(PEG)is widely used as an additive because of its hydrophilic and chemically inert properties.However,there are been increasing reports of PEG allergies,including anaphylaxis,although they are still rare.This case report aims to raise awareness,that the commonly used bowel cleansing agent containing PEG can cause serious allergic reactions.CASE SUMMARY Prior to surgery for sigmoid colon cancer,a 63-year-old man was prescribed a bowel cleansing agent containing PEG.Within 30 min of ingestion,he developed symptoms of anaphylactic shock and did not respond to initial intramuscular epinephrine injection.Under diagnosis of anaphylaxis to PEG,he was stabilized with fluid hydration and continuous norepinephrine infusion.CONCLUSION While allergic reactions to PEG are rare,they can be life-threatening.Therefore,it is crucial for clinicians to be aware of this possibility and to diagnose and resuscitate patients immediately.

Randomized clinical trial comparing fixed-time split dosing and split dosing of oral Picosulfate regimen for bowel preparation

AIM To compare the efficacy of fixed-time split dose and split dose of an oral sodium picosulfate for bowel preparation.METHODS This is study was prospective, randomized controlled study performed at a single Institution(2013-058). A total of 204 subjects were assigned to receive one of two sodium picosulfate regimens(i.e., fixed-time split or split) prior to colonoscopy. Main outcome measurements were bowel preparation quality and subject tolerability.RESULTS There was no statistical difference between the fixedtime split dose regimen group and the split dose regimen group(Ottawa score mean 2.57 ± 1.91 vs 2.80 ± 2.51, P = 0.457). Cecal intubation time and physician's satisfaction of inspection were not significantly different between the two groups(P = 0.428, P = 0.489). On subgroup analysis, for afternoon procedures, the fixed-time split dose regimen was equally effective as compared with the split dose regimen(Ottawa score mean 2.56 ± 1.78 vs 2.59 ± 2.27, P = 0.932). There was no difference in tolerability or compliance between the two groups. Nausea was 21.2% in the fixed-time split dose group and 14.3% in the split dose group(P = 0.136). Vomiting was 7.1% and 2.9%(P = 0.164), abdominal discomfort 7.1% and 4.8%(P = 0.484), dizziness 1% and 4.8%(P = 0.113), cold sweating 1% and 0%(P = 0.302) and palpitation 0% and 1%(P = 0.330), respectively. Sleep disturbance was two(2%) patients in the fixed-time split dose group and zero(0%) patient in the split dose preparation(P = 0.143) group.CONCLUSION A fixed-time split dose regimen with sodium picosulfate is not inferior to a split dose regimen for bowel preparation and equally effective for afternoon colonoscopy.

Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy

AIM： To investigate the effectiveness of low-volume plus ascorbic acid [polyethylene glycol plus ascorbic acid （PEG ＋ Asc）] and high-volume plus simethicone [polyethylene glycol plus simethicone （PEG ＋ Sim）] bowel preparations. METHODS： A total of one hundred and forty-four outpatients （76 males）, aged from 20 to 84 years （median age 59.5 years）, who attended our Department, were divided into two groups, age and sex matched, and underwent colonoscopy. Two questionnaires, one for patients reporting acceptability and the other for endoscopists evaluating bowel cleansing effectiveness according to validated scales, were completed. Indications, timing of examination and endoscopical findings were recorded. Biopsy forceps were used as a measuring tool in order to determine polyp endoscopic sizeestimation. Difficulty in completing the preparation was rated in a 5-point Likert scale （1 = easy to 5 = unable）. Adverse experiences （fullness, cramps, nausea, vomiting, abdominal pain, headache and insomnia）, number of evacuations and types of activities performed during preparation （walking or resting in bed） were also investigated. RESULTS： Seventy-two patients were selected for each group. The two groups were age and sex matched as well as being comparable in terms of medical history and drug therapies taken. Fourteen patients dropped out from the trial because they did not complete the preparation procedure. Ratings of global bowel cleansing examinations were considered to be adequate in 91% of PEG ＋ Asc and 88% of PEG ＋ Sim patients. Residual Stool Score indicated similar levels of amount and consistency of residual stool; there was a significant difference in the percentage of bowel wall visualization in favour of PEG ＋ Sim patients. In the PEG ＋ Sire group, 12 adenomas≤ 10 mm diameter （5/left colon ＋ 7/right colon） vs 9 （8/left colon ＋ 1/right colon） in the PEG ＋ Asc group were diagnosed. Visualization of small lesions seems to be one of the primary advantages of the PEG ＋ Sim preparation. CONCLUSION： PEG ＋ Asc is a good alternative solution as a bowel preparation but more improvements are necessary in order to achieve the target of a perfect preparation.

Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation

AIM： To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy.METHODS： A prospective, double-blind, randomized, placebo-controlled study was conducted. One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation. Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation. Total colonoscopic time, side effects of the medication, endoscopist and patient satisfaction were also compared.RESULTS： Sodium phosphate plus simethicone, compared to sodium phosphate plus placebo, improved visibility by diminishing air bubbles （100.00% vs 42.37%, P 〈 0.0002） but simethicone failed to demonstrate improvement in adequacy of colon preparation （90.16% vs 81.36%, P = 0.17）. Endoscopist and patient satisfaction were increased significantly in the simethicone group. However, there was no difference in the total duration of colonoscopy and side effects of the medication.CONCLUSION： The addition of simethicone is of benefit for colonoscopic bowel preparation by diminishing air bubbles, which results in enhanced visibility. Endoscopist and patient satisfaction is also increased.

Magnesium citrate with a single dose of sodium phosphate for colonoscopy bowel preparation

AIM:To evaluate the efficacy and acceptability of magnesium citrate and a single dose of oral sodium phosphate(45 mL) solution for morning colonoscopy bowel preparation. METHODS:A total of 159 patients were randomly assigned to receive two split doses of 90 mg of sodium phosphate(GroupⅠ,n=79) or magnesium citrate(250 mL,the day before the procedure) followed by 45 mL of sodium phosphate(the day of procedure,GroupⅡ,n= 80) .The quality of bowel cleansing and the acceptability of each regimen were compared,including the satisfaction,taste,willing to repeat and adverse effects of each regimen. RESULTS:The quality of bowel cleansing of GroupⅡ was as good as that of GroupⅠ(An Aronchick scale score of good or excellent:70.9%vs 81.0%,respectively,P=0.34;the Ottawa system score:4.4±2.6 vs 3.8 ±3.0,respectively,P=0.76) .There was no statisticallysignificant difference between both groups with regard to acceptability,including the satisfaction,taste and willingness to repeat the regimen.A significantly greater number of older patients(over 65 years old) in Group Ⅱgraded the overall satisfaction as satisfactory(48.1% vs 78.1%,respectively;GroupⅠvs GroupⅡ,P=0.01) . There were no significant adverse reactions. CONCLUSION:Magnesium citrate and a single dose of sodium phosphate was as effective and tolerable as the conventional sodium phosphate regimen and is a satisfactory option.

Withdrawal time in excellent or very poor bowel preparation qualities

AIM: To evaluate association(s) between withdrawal time and polyp detection in various bowel preparation qualities. METHODS: Retrospective cohort analysis of screening colonoscopies performed between January 2005 and June 2011 for patients with average risk of colorectal cancer. Exclusion criteria included patients with a personal history of adenomatous polyps or colon cancer, prior colonic resection, significant family history of colorectal cancer, screening colonoscopy after other abnormal screening tests such as flexible sigmoidoscopy or barium enema, and screening colonoscopies during in-patient care. All procedures were performed or directly supervised by gastroenterologists. Main measurements were number of colonic segments with polyps and total number of colonic polyps.RESULTS: Multivariate analysis of 8331 colonosco-pies showed longer withdrawal time was associated with more colonic segments with polyps in good(adjusted OR = 1.16; 95%CI: 1.13-1.19), fair(OR = 1.13; 95%CI: 1.10-1.17), and poor(OR = 1.18; 95%CI: 1.11-1.26) bowel preparation qualities. A higher number of total polyps was associated with longer withdrawal time in good(OR = 1.15; 95%CI: 1.13-1.18), fair(OR = 1.13; 95%CI: 1.10-1.16), and poor(OR = 1.20; 95%CI: 1.13-1.29) bowel preparation qualities. Longer withdrawal time was not associated with more colonic segments with polyps or greater number of colonic polyps in bowel preparations with excellent(OR = 1.07, 95%CI: 0.99-1.26; OR = 1.11, 95%CI: 0.99-1.24, respectively) and very poor(OR = 1.02, 95%CI: 0.99-1.12; OR = 1.05, 95%CI: 0.99-1.10, respectively) qualities.CONCLUSION: Longer withdrawal time is not associated with higher polyp number detected in colonoscopies with excellent or very poor bowel preparation quality.

Efficacy and tolerability of high and low-volume bowel preparation compared:A real-life single-blinded large-population study

BACKGROUND Low-volume preparations for colonoscopy have shown similar efficacy compared to high-volume ones in randomized controlled trials(RCT).However,most RCTs do not provide data about clinical outcomes including lesions detection rate.Moreover,real-life comparisons are lacking.AIM To compare efficacy(both in terms of adequate bowel preparation and detection of colorectal lesions)and tolerability of a high-volume(HV:4 L polyethylene glycol,PEG)and a low-volume(LV:2 L PEG plus bisacodyl)bowel preparation in a real-life setting.METHODS Consecutive outpatients referred for colonoscopy were prospectively enrolled between 1 December 2014 and 31 December 2016.Patients could choose either LV or HV preparation,with a day-before schedule for morning colonoscopies and a split-dose for afternoon procedures.Adequate bowel preparation according to Boston Bowel Preparation Scale(BBPS),clinical outcomes including polyp detection rate(PDR),adenoma detection rate(ADR),advanced adenoma detection rate(AADR),sessile/serrated lesion detection rate(SDR)and cancer detection rate and self-reported tolerability of HV and LV were blindly assessed.RESULTS Total 2040 patients were enrolled and 1815(mean age 60.6 years,50.2%men)finally included.LV was chosen by 52%of patients(50.8%of men,54.9%of women).Split-dose schedule was more common with HV(44.7%vs 38.2%,P=0.005).High-definition scopes were used in 33.4%of patients,without difference in the two groups(P=0.605).HV and LV preparations showed similar adequate bowel preparation rates(89.2%vs 86.6%,P=0.098),also considering the two different schedules(HV split-dose 93.8%vs LV split-dose 93.6%,P=1;HV daybefore 85.5%vs LV day-before 82.3%,P=0.182).Mean global BBPS score was higher for HV preparations(7.1±1.7 vs 6.8±1.6,P<0.001).After adjustment for sex,age and indications for colonoscopy,HV preparation resulted higher in PDR[Odds ratio(OR)1.32,95%CI:1.07-1.63,P=0.011]and ADR(OR 1.29,95%CI 1.02–1.63,P=0.038)and comparable to LV in AADR(OR 1.51,95%CI 0.97-2.35,P=0.069),SDR and cancer detection rate.The use of standard-definition colonoscopes was associated to lower PDR(adjusted OR 1.59,95%CI:1.22-2.08,P<0.001),ADR(adjusted OR 1.71,95%CI:1.26–2.30,P<0.001)and AADR(adjusted OR 1.97,95%CI:1.09-3.56,P=0.025)in patients receiving LV preparation.Mean Visual Analogue Scale tolerability scored equally(7,P=0.627)but a≥75%dose intake was more frequent with LV(94.6%vs 92.1%,P=0.003).CONCLUSION In a real-life setting,PEG-based low-volume preparation with bisacodyl showed similar efficacy and tolerability compared to standard HV preparation.However,with higher PDR and ADR,HV should still be considered as the reference standard for clinical trials and the preferred option in screening colonoscopy,especially when colonoscopy is performed with standard resolution imaging.

Efficiency of bowel preparation for capsule endoscopy examination:A meta-analysis

Good preparation before endoscopic procedures is essential for successful visualization. The small bowel is difficult to evaluate because of its length and complex configuration. A meta-analysis was conducted of studies comparing small bowel visualization by capsule endoscopy with and without preparation. Medical data bases were searched for all studies investigating the preparation for capsule endoscopy of the small bowel up to July 31, 2007. Studies that scored bowel cleanness and measured gastric and small bowel transit time and rate of cecum visualization were included. The primary endpoint was the quality of bowel visualization. The secondary endpoints were transit times and proportion of examinations that demonstrated the cecum, with and without preparation. Meta-analysis was performed with StatDirect Statistical software, version 2.6.1 (http:// statsdirect.com). Eight studies met the inclusion criteria. Bowel visualization was scored as "good" in 78% of the examinations performed with preparation and 49% performed without (P < 0.0001). There were no significant differences in transit times or in the proportion of examinations that demonstrated the cecum with and without preparation. Capsule endoscopy preparation improves the quality of small bowel visualization, but has no effect on transit times, or demonstration of the cecum.

Cleansing efficacy and safety of bowel preparation protocol using sodium picosulfate/magnesium citrate considering subjective experiences:An observational study

BACKGROUND Research data from patient reports indicate that the least bearable part of colonoscopy is the administration of laxatives for bowel preparation.AIM To observe the intestinal cleansing efficacy and safety of sodium picosulfate/magnesium citrate and to discuss the patients’experiences due to the procedure.METHODS Subjects hospitalized in the International Medical Center Ward of Peking University International Hospital,Beijing,China,from April 29 to October 29,2020,for whom the colonoscopy was planned,were enrolled.Bowel preparation was performed using sodium picosulfate/magnesium citrate.The effect of bowel cleansing was evaluated according to the Ottawa Bowel Preparation Scale,defecation conditions and adverse reactions were recorded,and the comfort level and subjective satisfaction concerning medication were evaluated by the visual analogue scale/score(VAS).RESULTS The bowel preparation procedure was planned for all patients enrolled,which included 42 males and 22 females.The results showed an average liquid rehydration volume of 3000 mL,an average onset of action for the first dose at 89.04 min,an average number of bowel movements of 4.3 following the first dose,an average onset of action for the second dose at 38.90 min and an average number of bowel movements of 5.0 after the second dose.The total average Ottawa Bowel Preparation Scale score was 3.6,with 93.55%of bowel preparations in the“qualified”and 67.74%in the“excellent”grade.The average VAS score of effect on sleep was 0,and the average VAS score of perianal pain was also 0.The average VAS score for ease of taking and taste perception of the bowel cleanser was 10.Side effects included mild to moderate nausea(15.63%),mild vomiting(4.69%),mild to moderate abdominal pain(7.81%),mild to moderate abdominal distension(20.31%),mild palpitation(7.81%)and mild dizziness(4.69%).CONCLUSION Sodium picosulfate/magnesium citrate is effective and safe for bowel preparation before colonoscopy with high subjective patient acceptance,thus improving overall patient compliance.

Evidence-based considerations on bowel preparation for colonoscopy

We recently read with interest the article,“Novel frontiers of agents for bowel cleansing for colonoscopy”.This is a practical narrative review,which could be of particular importance to clinicians in order to improve their current practice.Although we appreciate the venture of our colleagues,based on our in-depth analysis,we came across several minor issues in the article;hence,we present our comments in this letter.If the authors consider these comments further in their relevant research,we believe that their contribution would be of considerable importance for future studies.

Analysis of YouTube^(TM) videos related to bowel preparation for colonoscopy

AIM: To examine YouTubeTM videos about bowel preparation procedure to better understand the quality of this information on the Internet. METHODS: YouTubeTM videos related to colonoscopy preparation were identified during the winter of 2014; only those with ≥ 5000 views were selected for analysis(n = 280). Creator of the video, length, date posted, whether the video was based upon personal experience, and theme was recorded. Bivariate analysis was conducted to examine differences between consumers vs healthcare professionals-created videos. RESULTS: Most videos were based on personal experience. Half were created by consumers and 34% were ≥ 4.5 min long. Healthcare professional videos were viewed more often(】 19400, 59.4% vs 40.8%,P = 0.037, for healthcare professional and consumer, respectively) and more often focused on the purgative type and completing the preparation. Consumer videos received more comments(】 10 comments, 62.2% vs 42.7%, P = 0.001) and more often emphasized the palatability of the purgative, disgust, and hunger during the procedure. Content of colonoscopy bowel preparation YouTube? videos is influenced by who creates the video and may affect views on colon cancer screening. CONCLUSION: The impact of perspectives on the quality of health-related information found on the Internet requires further examination.

The effects of enteral nutrition in the bowel preparation in patients with diabetes mellitus

Objective:The objective of the study was to investigate the effect of enteral nutrients in diabetic patients with fibrocolonoscopy.Materials and Methods:A total of 58 diabetic patients undergoing fibrocolonoscopy from January 2017 to December 2017 were included as the traditional bowel preparation group.The patients took traditional semi‑flow diet and catharsis as intestinal preparation and were given health education.Sixty patients treated with fibrocolonoscopy from July to December in 2018 were included as the enteral nutrition group and received enteral nutrients and catharsis as intestinal preparation and were given modified health education.The incidence of hypoglycemia during intestinal preparation was compared between the two groups.Results:A total of 20(34.48%)patients in the traditional bowel preparation group had hypoglycemia(including asymptomatic hypoglycemia)during bowel preparation,with the total frequency of 40.The blood glucose level fluctuated between 1.7 and 3.9 mmol/L.Only five patients in the enteral nutrition group had hypoglycemia(including asymptomatic hypoglycemia)during bowel preparation.The incidence of hypoglycemia was lower in the enteral nutrition group than that in the traditional bowel preparation group(χ^2=4.937,P=0.026).Conclusion:The enteral nutrients as diet for fibrocolonoscopy bowel preparation and strengthening health education could reduce the incidence of hypoglycemia in patients with diabetes during bowel preparation and ensure patient safety.

Same-day single-dose vs large-volume split-dose regimens of polyethylene glycol for bowel preparation:A systematic review and meta-analysis

BACKGROUND Split-dose regimens(SpDs)of 4 L of polyethylene glycol(PEG)have been established as the“gold standard”for bowel preparation;however,its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses.Meanwhile,the same-day single-dose regimens(SSDs)of PEG has been recommended as an alternative;however,its superiority compared to other regimens is a matter of debate.AIM To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation.METHODS We searched MEDLINE/PubMed,the Cochrane Library,RCA,EMBASE and Science Citation Index Expanded for randomized trials comparing(2 L/4 L)SSDs to large-volume(4 L/3 L)SpDs PEG-based regimens,regardless of adjuvant laxative use.The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness,sleep disturbance,willingness to repeat the procedure using the same preparation and adverse effects.A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies.RESULTS A total of 18 studies were included.There was no statistically significant difference of adequate bowel preparation(relative risk=0.97;95%CI:0.92-1.02)(14 trials),right colon Boston Bowel Preparation Scale(mean difference=0.00;95%CI:-0.04,0.03)(9 trials)and right colon Ottawa Bowel Preparation Scale(mean difference=0.04;95%CI:-0.27,0.34)(5 trials)between(2 L/4 L)SSDs and large-volume(4 L/3 L)SpDs,regardless of adjuvant laxative use.The pooled analysis favored the use of SSDs with less sleep disturbance(relative risk=0.52;95%CI:0.40,0.68)and lower incidence of abdominal pain(relative risk=0.75;95%CI:0.62,0.90).During subgroup analysis,patients that received low-volume(2 L)SSDs showed more willingness to repeat the procedure using the same preparation than SpDs(P<0.05).No significant difference in adverse effects,including nausea,vomiting and bloating,was found between the two arms(P>0.05).CONCLUSION Regardless of adjuvant laxative use,the(2 L/4 L)SSD PEG-based arm was considered equal or better than the large-volume(≥3 L)SpDs PEG regimen in terms of bowel cleanliness and tolerability.Patients that received low-volume(2 L)SSDs showed more willingness to repeat the procedure using the same preparation due to the low-volume fluid requirement and less sleep disturbance.