Modern Medicine (Jun 2024)

Adequate Colon Preparation in Screening Colonoscopy

  • Marina COZMA,
  • Elena CONSTANTIN,
  • Lucian NEGREANU

DOI
https://doi.org/10.31689/rmm.2024.31.2.103
Journal volume & issue
Vol. 31, no. 2
pp. 103 – 107

Abstract

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Colorectal cancer (CRC) is one of the most common forms of cancer worldwide, being the fourth most prevalent cancer and the third most common in terms of mortality. A decrease in the incidence and mortality of CRC has been observed among adults over 50 years of age, screening colonoscopy being a contributory factor for this improvement. Adequate preparation of the colon is essential for obtaining accurate results and minimizing the risks associated with the colonoscopy procedure. Both ESGE (European Society of Gastrointestinal Endoscopy) and UEG (United European Gastroenterology) recommend adequate preparation in at least 90% of cases, calculated both at the endoscopy center level and for each individual endoscopist. The purpose of our article is to review the literature on different bowel preparation products for colonoscopy and demonstrate the non inferiority of low-volume preparations over the standard PEG 4L. Preparations containing PEG are the most common in preparation for colonoscopy. A recent meta-analysis suggests that high-volume, mutiple-dose regimens are superior in terms of efficacy to low-volume, multiple- dose regimens, including low-volume PEG with various adjuvants and sodium phosphate, although with lower tolerability. Due to low levels of compliance, tolerability and acceptability, standard 4L single-dose regimens of PEG have been gradually and successfully replaced by newer regimens that include low-volume solutions. An example of low-volume split-dose preparation is the solution of low-volume PEG4000, sodium sulphate, citric acid, sodium citrate, sodium chloride, potassium chloride and simethicone. In several studies this 2 L low volume preparations exhibit similar effectiveness with safety profiles that are comparable to classic 4 L PEG, with lower incidence of adverse effects and good tolerability. In conclusion, adequate preparation increases the quality of colonoscopy procedures as proper patient preparation is essential to obtain an optimal visualization of the intestinal mucosa. Low-volume bowel preparation is effective, safe and well tolerated by the patients, with higher acceptability compared to the standard volume PEG.

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