Colon Cleaning after Inadequate Bowel Preparation: A Pooleddata Analysis

Abstract

Background and Aims: An adequate bowel preparation is essential for performing high-quality ccolonoscopy; however, it remains ineffective for a certain percentage of patients. We conducted a literature search to identify evidence on salvage strategies following inadequate bowel preparation.

Methods: The search of medical literature was conducted using Medline and Google Scholar, restricted to studies published in English as a full paper. From retrieved studies, the success rate was calculated according to the rescue approaches used, including different oral- or device-assisted procedures, and pooling data of similar approaches.

Results: By considering data of 17 studies with 2,167 patients, an adequate colon cleaning was overall achieved in 79.3% (95%CI: 77.5-80.1). By grouping data of similar approaches, the success rate was 78.1% with oral high-volume polyethylene glycol (PEG), 75.3% with low-volume PEG, 82.5% with oral sennosides, and 84.6% following colonoscope or device-assisted preparation.

Conclusions: Effective bowel cleansing is not achieved in nearly 20% of patients due to inadequate bowel preparation and although multiple approaches have been investigated, none has consistently provided adequate bowel preparation for all patients.