Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2016; 22(10): 2915-2921
Published online Mar 14, 2016. doi: 10.3748/wjg.v22.i10.2915
Combination could be another tool for bowel preparation?
Jae Seung Soh, Kyung-Jo Kim
Jae Seung Soh, Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang 14068, South Korea
Kyung-Jo Kim, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Soh JS and Kim KJ performed the literature review, analyzed the collected data and wrote the manuscript; Kim KJ supervised the review.
Conflict-of-interest statement: Nothing to declare and no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kyung-Jo Kim, MD, Department of Gastroenterology, Asan Medical Center, University of Ulsan College Of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. capsulendos@gmail.com
Telephone: +82-2-30103196 Fax: +82-2-30108043
Received: June 28, 2015
Peer-review started: July 1, 2015
First decision: September 9, 2015
Revised: September 23, 2015
Accepted: December 12, 2015
Article in press: December 14, 2015
Published online: March 14, 2016
Abstract

Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol (PEG) solution is the most frequently used preparation for bowel cleansing, patients are often unwilling to take PEG solution due to its large volume, poor palatability, and high incidence of adverse events, such as abdominal bloating and nausea. Other purgatives include osmotic agents (e.g., sodium phosphate, magnesium citrate, and sodium sulfate), stimulant agents (e.g., senna, bisacodyl, and sodium picosulfate), and prokinetic agents (e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients’ adherence. Some such solutions have been found in several published studies to not be inferior to PEG alone in terms of bowel cleansing quality. Although combination methods showed similar efficacy and safety, the value of these studies is limited by shortcomings in study design. New effective and well-tolerated combination preparations are required, in addition to rigorous new validated studies.

Keywords: Bowel preparation, Colonoscopy, Inadequate bowel cleansing, Combination methods, Intolerance

Core tip: Selecting optimal purgatives is essential for achieving effective bowel preparation. Although polyethylene glycol is the most widely used solution, there are several agents for bowel cleansing including osmotic and stimulant agents. Thus, combination methods of these agents could be an option to improve the cleansing quality and patients’ adherence. We reviewed comparison studies between combination and single agent preparations. The biggest benefit of combinations in most studies is to reduce the volume of cleansing solutions, which could improve patients’ compliance for bowel preparation. However, new effective and well-tolerated combination preparations are required for more effective bowel preparations.