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Split‐dose bowel preparation with polyethylene glycol for colonoscopy performed under propofol sedation. Is there an optimal timing?
Author(s) -
Alghamry Alaa,
Ponnuswamy Sureshkumar K,
Agarwal Aditya,
Moattar Hadi,
Yerkovich Stephanie T,
Vandeleur Ann E,
Thomas James,
Croese John,
Rahman Tony,
Hodgson Ruth
Publication year - 2017
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12458
Subject(s) - medicine , colonoscopy , sedation , esophagogastroduodenoscopy , propofol , anesthesia , liter , bowel preparation , surgery , alfentanil , gastroenterology , endoscopy , colorectal cancer , cancer
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 p H 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 p H was found ( r = −0.017, P = 0.62 and r = −0.030, P = 0.47, respectively). RGV and p H 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 p H as those achieved by more prolonged fasting, with no increased risk of aspiration even in patients perceived to be at high risk.