Comparison between pulsed irrigation enhanced evacuation and polyethylene glycol-electrolyte lavage solution for bowel preparation prior to elective colonoscopy in veterans with spinal cord injury

Abstract

Background: Poor preparation for elective colonoscopy is common in persons with spinal cord injury (SCI). This unsatisfactory outcome is likely due to long-standing difficulty with evacuation and decreased colonic motility. Our objective was to determine the most effective preparation for elective colonoscopy applying a novel and traditional approach to bowel cleansing.

Methods: Twenty-four subjects with SCI were consented and scheduled to receive one of the two possible arms: pulsed irrigation enhanced evacuation (PIEE) or polyethylene glycol-electrolyte lavage solution (PEG; CoLyte(®)). The quality of the preparation was scored during the colonoscopy by applying the Ottawa scoring system.

Results: Patients with SCI who received PIEE tended to have lower Ottawa scores and a higher percentage of acceptable preparations than did those who received PEG; however, the results were not statistically different.

Conclusion: In this preliminary study in subjects with SCI, neither PIEE nor PEG produced acceptable bowel preparation for elective colonoscopy. Future studies should confirm our findings and consider studying alternative, more efficacious approaches to bowel cleansing prior to colonoscopic procedures in patients with SCI, which should provide better outcomes. Registration number for clinicaltrials.gov: NCT00745095.

Keywords: Bowel preparations; Colonoscopy; Paraplegia; Polyethylene glycol; Polyp detection; Tetraplegia.

Figures

Figure 1

Study flow chart. Number of subjects assessed for eligibility: SCI, spinal cord injured; PIEE, pulsed irrigation enhanced evacuation; PEG, polyethylene glycol-electrolyte lavage. “Acceptable Prep” denotes colonoscopy preparations with an OS of ≤3.

Figure 2

OSs among the colonoscopy preparations. The individual OSs for each subject by preparation is presented (PIEE, pulsed irrigation enhanced evacuation; PEG, polyethylene glycol-electrolyte lavage solution). The OS were not significantly different between the preparation groups. The broken line represents the cutoff OS for an acceptable preparation (OS ≤ 3).