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A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

Steven D Wexner·David E Beck·Todd H Baron·Robert D Fanelli·Neil Hyman·Bo Shen·Kevin E Wasco
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CatharticsColonoscopyDietEnemaGastric LavageHumansPolyethylene GlycolsPreoperative CareJournal Article

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Steven D Wexner, David E Beck, Todd H Baron, Robert D Fanelli, Neil Hyman, Bo Shen, Kevin E Wasco. 2006. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).. https://doi.org/10.1007/s10350-006-0536-z

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PubMed2006

Preoperative bowel preparation: surgical standard or past?

BACKGROUND: Preoperative bowel preparation is still routinely used prior to colorectal surgery. This concept is based on traditional and personal empiricism and usually not evidence based. The objective of the present review was to reassess this dogma against the background of the highest level of evidence published thus far. METHODS: The Medline database was searched using the search terms 'preoperative', 'bowel' and 'preparation' limited to 'randomized controlled trials' and 'meta-analyses'. Ten randomised controlled trials and seven meta-analyses comparing orthograde bowel cleansing to no preoperative bowel preparation were considered for rates of anastomotic leakages, surgical infections and other types of complications, reoperations and mortality. RESULTS: All the most recent meta-analyses showed a significant increase of anastomotic dehiscences in patients with preoperative orthograde bowel cleansing. Additionally, a trend towards higher rates of surgical infectious complications and re-operations was revealed. Mortality remained unchanged by preoperative orthograde bowel cleansing. CONCLUSION: Routine preoperative orthograde bowel cleansing is no longer justified prior to colorectal surgery in general due to increased risk of anastomotic leakages. Further investigations should focus on different types of bowel preparation in situations where preoperative bowel preparation still may have a role such as total mesorectal resection with low anastomosis and protective ileostomy.

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PubMed2006

Is blinding the endoscopists to bowel preparations in randomized-controlled trials a reality?

BACKGROUND: A number of studies compared the quality, efficacy and tolerability of oral sodium phosphate (NaP) and polyethylene glycol (PEG)-based solutions in preparation for colonoscopy. The primary aim of this study was to explore whether endoscopists can be effectively blinded to the type of bowel preparation. METHODS: We recruited 3 experienced endoscopists and 57 outpatients (18-65 years old) undergoing colonoscopy. We randomized eligible patients to receive one of the two bowel preparations. Endoscopists who performed the tests were blinded to the type of preparation, and made their best judgment on the type and quality of the bowel preparation. RESULTS: Forty-five patients completed the study. The overall correct estimation of the type of bowel preparation was 60.0% (95% CI; 45.5%, 73.0%). The cleansing quality did not differ between the two preparations. Patients found oral NaP solution much easier to take (81.8% versus 36.4%; P = 0.005) and the PEG-based group tended to have more nausea or vomiting. 47.6% of patients in the PEG group indicated they would prefer to try another bowel preparation in the future compared to 4.5% in the oral NaP group (P = 0.002). We stopped the study after an interim analysis indicating that more than 600 patients would be required to detect statistically significant differences in the primary aim. CONCLUSION: Our findings suggest that blinding of endoscopists in clinical trials comparing oral NaP to PEG had a relatively low likelihood of bias. The study also suggests that oral NaP is easier to take and more tolerable than PEG without impairing cleansing quality.

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