Split-dose bowel preparation with polyethylene glycol for colonoscopy performed under propofol sedation. Is there an optimal timing?

Alghamry, Alaa, Ponnuswamy, Sureshkumar K., Agarwal, Aditya, Moattar, Hadi, Yerkovich, Stephanie T., Vandeleur, Ann E., Thomas, James, Croese, John, Rahman, Tony and Hodgson, Ruth (2017) Split-dose bowel preparation with polyethylene glycol for colonoscopy performed under propofol sedation. Is there an optimal timing?. Journal of Digestive Diseases, 18 3: 160-168. doi:10.1111/1751-2980.12458


Author Alghamry, Alaa
Ponnuswamy, Sureshkumar K.
Agarwal, Aditya
Moattar, Hadi
Yerkovich, Stephanie T.
Vandeleur, Ann E.
Thomas, James
Croese, John
Rahman, Tony
Hodgson, Ruth
Title Split-dose bowel preparation with polyethylene glycol for colonoscopy performed under propofol sedation. Is there an optimal timing?
Journal name Journal of Digestive Diseases   Check publisher's open access policy
ISSN 1751-2980
1751-2972
Publication date 2017-03-01
Sub-type Article (original research)
DOI 10.1111/1751-2980.12458
Open Access Status Not yet assessed
Volume 18
Issue 3
Start page 160
End page 168
Total pages 9
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 2715 Gastroenterology
Abstract OBJECTIVE: Aspiration risk, especially with propofol sedation, remains a concern after split-dose bowel preparation of up to 1 L polyethylene glycol for the procedure. We aimed to identify the ideal timing of bowel preparation to achieve optimal colon cleansing with no increased risk of aspiration. METHODS: A total of 892 consecutive patients undergoing simultaneous esophagogastroduodenoscopy (EGD) and colonoscopy were prospectively recruited. Residual gastric volume (RGV) and pH of gastric contents were measured at EGD, and patients' characteristics, runway time (duration between completion of the final liter of bowel preparation and colonoscopy commencement), and cleansing quality were recorded. RESULTS: A shorter runway time resulted in better colon cleansing (r = −0.124, P < 0.001). No correlation between runway time and RGV or pH was found (r = −0.017, P = 0.62 and r = −0.030, P = 0.47, respectively). RGV and pH did not differ significantly with runway time of 4 or 5 h. RGV with runway time ≤3 h was 35.9 ± 11.8 mL and 17.4 ± 0.6 mL after runway time >3 h (P < 0.001). No aspiration pneumonia occurred. The only factors independently related to higher RGV were younger age and male sex. CONCLUSIONS: The consumption of bowel preparation agent within 3–4 h before propofol sedation resulted in a similar RGV and pH as those achieved by more prolonged fasting, with no increased risk of aspiration even in patients perceived to be at high risk.
Formatted abstract
Objective: Aspiration risk, especially with propofol sedation, remains a concern after split-dose bowel preparation of up to 1 L polyethylene glycol for the procedure. We aimed to identify the ideal timing of bowel preparation to achieve optimal colon cleansing with no increased risk of aspiration.

Methods: A total of 892 consecutive patients undergoing simultaneous esophagogastroduodenoscopy (EGD) and colonoscopy were prospectively recruited. Residual gastric volume (RGV) and pH of gastric contents were measured at EGD, and patients' characteristics, runway time (duration between completion of the final liter of bowel preparation and colonoscopy commencement), and cleansing quality were recorded.

Results: A shorter runway time resulted in better colon cleansing (r = −0.124, P < 0.001). No correlation between runway time and RGV or pH was found (r = −0.017, P = 0.62 and r = −0.030, P = 0.47, respectively). RGV and pH did not differ significantly with runway time of 4 or 5 h. RGV with runway time ≤3 h was 35.9 ± 11.8 mL and 17.4 ± 0.6 mL after runway time >3 h (P < 0.001). No aspiration pneumonia occurred. The only factors independently related to higher RGV were younger age and male sex.

Conclusions:The consumption of bowel preparation agent within 3–4 h before propofol sedation resulted in a similar RGV and pH as those achieved by more prolonged fasting, with no increased risk of aspiration even in patients perceived to be at high risk.
Keyword Aspiration pneumonia
Colonoscopy
Polyethylene glycols
Residual gastric volume
Split-dose bowel preparation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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