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BACKGROUND: Oral sulfate tablets (OSTs) are bowel preparation agents that combine oral sulfate solution and simethicone. This study compared the efficacy, tolerability, and safety of OST compared to 2 L-polyethylene glycol plus ascorbic acid (2 L-PEG/ASC). METHODS: This prospective, randomized, controlled, single-blinded, multicenter, noninferiority trial enrolled 211 healthy adults who underwent colonoscopy between May 2020 and September 2022 at 13 university hospitals. The bowel cleansing rate was assessed using the Boston Bowel Preparation Scale (BBPS) and Harefield Cleansing Scale (HCS), and the preparation agents were administered in split regimens. RESULTS: The total BBPS score (8.2 ± 1.5 vs. 7.8 ± 1.4, p = 0.040) and the high-quality bowel cleansing rates in the right colon (73.2% vs. 50.5), transverse colon (80.6% vs. 68.0%), and left colon (81.5% vs. 67.0%) on the BBPS were significantly higher in the OST group than in the 2 L-PEG/ASC group. However, the rates of successful cleansing according to BBPS (90.7% vs. 91.2%) and HCS (96.3% vs. 94.2%) did not significantly differ between the two groups. The taste, ease, and amount of consumption of the preparation agent; and willingness to repeat colonoscopy with the same agent (89.8% vs. 78.6%, P = 0.026) were significantly better in the OST group compared to the 2 L-PEG/ASC group. Adverse events and clinically significant laboratory changes were not significantly different between the two groups. CONCLUSION: The OST was not inferior to 2 L-PEG/ASC in terms of bowel cleansing efficacy and showed better tolerability when used for bowel preparation for colonoscopy. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0005017.

Objective: This study evaluates the effectiveness of combining oral polyethylene glycol electrolyte solution with hypertonic sugar saline enema for colonoscopy preparation in autistic children. Methods: Clinical data of 58 children with autism who underwent fecal bacteria transplantation and transendoscopic enteral tubing (TET) catheterization at the hospital were retrospectively analyzed. Participants were allocated into 2 groups: a control group (26 children) and an observation group (32 children), differentiated by their intestinal preparation protocols. The control group was administered oral polyethylene glycol combined with normal saline enema, whereas the observation group was given oral polyethylene glycol combined with hypertonic sugar saline enema. The Boston Bowel Preparation Scale (BBPS) was used to score intestinal cleanliness. Differences in intestinal cleanliness and colonoscopy duration between the 2 groups were compared. Results: The group treated with hypertonic sugar saline enema exhibited significantly higher BBPS scores (6.78 ± 0.83) and an intestinal passage rate of 96.86%, which were statistically significant compared with the control group (P < 0.05). In addition, the colonoscopy duration was notably shorter in the observation group (14.03 ± 4.86 minutes) compared with the control group (P < 0.05) Conclusion: Our findings suggest that an oral polyethylene glycol electrolyte solution combined with a hypertonic sugar saline enema is a more effective preparation method for colonoscopy in autistic children. [ABSTRACT FROM AUTHOR]

Background: Polyethylene glycol electrolyte solution (PEG-ELS) is the standard for bowel preparation but often suffers from poor patient compliance and tolerability due to its high-volume requirement. This prospective, single-blinded, non-inferiority, randomized control trial aims to investigate the efficacy and safety of a lactulose-based regimen as an alternative for bowel preparation. Methods: Two hundred nine patients were randomly allocated to receive either a combination regimen consisting of 133.4 g lactulose in 200 mL, 800 mL carbohydrate-containing clear liquid, 2L additional water, and 5 g simethicone (n = 104) or 3L PEG-ELS with 5 g simethicone (n = 105), both administered in a split-dose format. The primary outcome was the rate of adequate bowel preparation, measured by the Boston bowel preparation score (BBPS). Adequate bowel preparation was defined as a BBPS score of 2 or 3 in all colon segments. Secondary outcomes included the percentage of high-quality bowel preparation (defining as a total BBPS score of 8 or 9), polyp detection rate (defining as the percentage of procedures where at least one polyp was detected), willingness to repeat the bowel preparation, adverse events, and changes in blood glucose and electrolyte levels. Results: The rate of adequate bowel preparation (96.2% vs. 97.1%, p = 0.691), the percentage of high-quality preparation (62.5% vs. 66.7%, p = 0.529), average total BBPS scores (p = 0.607), polyp detection rates (66.3% vs. 77.1%, p = 0.083), and tolerability and acceptability outcomes, including satisfaction (p = 0.729) and willingness to repeat preparation (p = 0.744), were not statistically different between the two arms. Adverse events and changes in blood glucose and electrolytes showed no significant differences (all p > 0.05). Conclusion: The combination of oral lactulose and carbohydrate-containing clear fluids was non-inferior to 3L PEG-ELS for bowel preparation adequacy and polyp detection, without statistically significant differences in terms of tolerability and safety. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this single-blind, single-center clinical trial study was to compare the effect of a clear liquid diet versus mechanical bowel preparation (MBP) before surgery on surgical field visualization, postoperative pain, and postoperative symptoms in women undergoing benign gynecological laparoscopic surgeries. Materials and Methods: A total of 120 women scheduled for benign gynecological laparoscopic surgery were allocated to two groups. In group 1 from 24 hours before the surgery, the patient was on a clear liquid diet and should have been fasting 8 hours before the surgery (Diet group). Group 2 received four packets of polyethylene glycol powder in the evening before the operation and was fasting from midnight before the operation (MBP group). The outcomes included the comparison of intraoperative visualization of the surgical field, ease of bowel handling, postoperative pain, and gastrointestinal discomforts between the two groups. Results: The intraoperative visualization of the surgical field score (p = 0.06) and ease of small and large bowel handling rating were similar between the two groups (p = 0.19 and 0.59, respectively). Compared with the MBP group, patients in the Diet group experienced fewer complications including abdominal pain, vomiting, anal stimulation, hunger, and postoperative flatulence. Conclusions: Administration of clear liquid diet 24 hours before surgery seems to have comparable results with MBP in terms of surgical field of view and ease of bowel handling. However, fewer gastrointestinal discomforts were observed in the diet group. [ABSTRACT FROM AUTHOR]

Intrahepatic abscess is an exceedingly rare complication of locoregional therapy for patients with liver cancer. However, in patients who underwent prior hepatobiliary intervention, the incidence of liver abscess increases significantly, causing morbidity and even mortality in such patients. Here, we will review the relative risk of developing a liver abscess after intraarterial and ablative locoregional therapies in patients with liver cancer depending on whether they underwent any kind of prior hepatobiliary procedures that resulted in violation of the Ampulla of Vater. As a result, patients deemed at high risk of developing a liver abscess were treated prophylactically, with the combination of bowel preparation and antibiotics nearly eliminating the occurrence of a liver abscess after locoregional therapy. Therefore, given the significant risk of developing a liver abscess in patients with prior hepatobiliary procedures, management consisting of prophylactic bowel preparation with antibiotic coverage followed by antibiotics post-locoregional therapy is recommended. [ABSTRACT FROM AUTHOR]

Bowel preparation represents a significant issue to high-quality colonoscopy. Oral mannitol requires a single dose, is of low volume, and has a pleasant taste and rapid action. This SATISFACTION study compared single-dose (same day) oral mannitol 100 g/750 mL with standard split-dose PEG-ASC2 L (MoviPrep®). The primary endpoint was the proportion of patients with adequate bowel cleansing. Secondary endpoints included efficacy (adenoma detection rate, caecal intubation rate, time of evacuation), safety (intestinal gases concentration, haemato-chemical parameters, adverse events), and patient satisfaction. The study included 703 patients (352 treated with mannitol and 351 with PEG-ASC). Mannitol was not inferior to PEG-ASC for the primary endpoint (91.1 % and 95.5 %, respectively; p-value for the non-inferiority =0.0131). There was no significant difference for secondary efficacy endpoints. The acceptability profile was significantly better in the mannitol group for ease of use, taste, and willingness to reuse (p < 0.0001 for all). The concentration of intestinal gases (H 2 , CH 4) was similar between groups and well below those potentially critical. The SATISFACTION study indicated that low-volume, single-dose mannitol may satisfy an unmet clinical need since it was more acceptable to the patient and not inferior to the split-dose PEG-ASC for bowel cleansing efficacy. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Bowel regimens (BR) before radical cystectomy (RC) are currently not recommended by Enhanced Recovery After Surgery (ERAS) protocols, as prior studies have shown BRs lead to worsened outcomes. However, many of those studies have used historic literature before recent surgical advancements such as minimally invasive RC and have not investigated the impact BRs have by type of urinary diversion. Our goal is to determine the outcomes of preoperative BR in patients undergoing RC based on diversion type using a modern patient cohort.RCs performed between 2019 and 2020 with BR information available were identified in the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP). Patients were grouped by type of BR received: no BR, both mechanical bowel preparation (MBP) and preoperative oral antibiotic BR (OABR), MBP only, and OABR only. We conducted propensity score matching based on factors influencing the operative approach. Baseline demographics and 30‐day complication rates were compared between matched groups. We analyzed hospital length of stay (LOS) via multivariate regression with a Poisson distribution.In total, 2054 RCs were identified with 2.4% receiving OABR, 21.3% receiving MBP, 5.3% receiving both, and 71.0% receiving no BR. For patients with ileal conduit diversions, outcomes with BRs appeared mixed, as OABR leads to increased LOS. For patients with neobladder diversions, BRs were not associated with any worsened outcomes and were associated with reduced length of stay.BRs such as OABR may associated with improved outcomes in patients receiving RC with neobladder diversion, a finding that warrants further investigation. [ABSTRACT FROM AUTHOR]

Background/Aims Colonoscopy is widely used as a diagnostic and preventive procedure for colorectal diseases. The most recent guidelines advocate the use of a low-residue diet (LRD) for bowel preparation before colonoscopy. LRD duration varies considerably, with recommended 1-day and multiple-day regimens in clinical practice. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched multiple databases for randomized controlled trials (RCTs) and analyzed the outcomes using a fixed-effects model. Results Six RCTs with 2,469 subjects were included in this study. The rates of adequate bowel preparation for 1-day and >1-day were 87.2% and 87.1%, respectively. No statistically significant differences were observed between the 1-day and >1-day LRD in adequate bowel preparation (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.76–1.41; p=0.84; I²=0%), polyp detection rate (OR, 0.91; 95% CI, 0.76–1.09; p=0.29; I²=16%), adenoma detection rate (OR, 0.87; 95% CI, 0.71–1.08; p=0.21; I²=0%), and withdrawal time (mean difference, –0.01; 95% CI, –0.25 to 0.24; p=0.97; I²=63%).

Background: High-quality bowel preparation is paramount for a successful colonoscopy. This study aimed to explore the effect of artificial intelligence-driven smartphone software on the quality of bowel preparation. Methods: Firstly, we utilized 3305 valid liquid dung images collected via mobile phones as training data. the most effective model was employed on mobile phones to evaluate the quality of bowel preparation. Secondly, From May 2023 to September 2023, colonoscopy patients were randomly assigned to two groups – the AI group (n = 116) and the control group (n = 116) – using a randomized, controlled, endoscopist-blinded method. We compared the two groups in terms of Boston Bowel Preparation Scale (BBPS) scores, polyp detection rate, adverse reaction rate, and factors related to bowel preparation quality. The primary endpoint was the percentage of patients who achieved a BBPS ≥6 among those who effectively utilized the smartphone software. Results: EfficientNetV2 exhibited the highest performance, with an accuracy of 87%, a sensitivity of 83%, and an AUC of 0.86. In the patient validation experiment, the AI group had higher BBPS scores than the control group (6.78 ± 1.41 vs. 5.35 ± 2.01, p = 0.001) and showed an improvement in the detection rate (71.55% vs. 56.90%, p = 0.020) for polyps. Multifactor logistic analysis indicated that compliance with enema solution usage rules (OR: 5.850, 95% confidence interval: 2.022–16.923), total water intake (OR: 1.001, 95% confidence interval: 1.001–1.002), and AI software reminders (OR: 2.316, 95% confidence interval: 1.096–4.893) were independently associated with BBPS scores ≥6. Conclusion: Compared with traditional methods, the use of artificial intelligence combined with software to send reminders can lead to more accurate assessments of bowel preparation quality and an improved detection rate for polyps, thus demonstrating promising clinical value. [ABSTRACT FROM AUTHOR]

Introduction: Suboptimal bowel preparation adversely affects colonoscopy quality, increases healthcare costs, and prolongs waiting time. The primary contributing factors include poor tolerance to the preparation solutions, noncompliance with prescribed instructions, and suboptimal efficacy of the bowel cleansing solution itself. Areas covered: This review examined the predictive factors associated with suboptimal bowel preparation and discussed interventions aimed at improving bowel cleansing. It also provides evidence-based practical algorithms supplemented by insights from our own clinical experience. Relevant topics were reviewed using resources from the PubMed database. Expert opinion: Although current bowel preparation protocols are effective for the majority of patients, a significant proportion still present challenges for optimal preparation. These patients may benefit from personalized strategies tailored to the specific causes of preparation failure. Conducting a thorough interview is crucial for identifying the reasons for failure, particularly in patients who have previously experienced suboptimal preparation during colonoscopy. In colonoscopy-naïve patients, it is essential to assess the risk of suboptimal preparation. In both cases, interventions should be customized to either address the identified causes in the former group or employ preventive strategies to reduce the likelihood of failure in the latter. [ABSTRACT FROM AUTHOR]

Background and Objectives: Colorectal cancer is the second leading cause of cancer-related deaths in the U.S., and colonoscopy is a critical tool for colon cancer screening and diagnosis. Electrolyte disturbances and autonomic nervous system dysfunction that may occur due to bowel preparation and the colonoscopy procedure itself may play a role in the development of cardiac arrhythmia. This study aimed to assess the index of cardiac–electrophysiological balance (iCEB) to predict ventricular arrhythmia risk related to colonoscopy. Materials and Methods: Patients undergoing elective colonoscopy with a normal sinus rhythm were included. Electrocardiography (ECG) recordings both before bowel preparation and after the colonoscopy procedure were obtained. Values of the index of cardiac–electrophysiological balance (iCEB) were compared. Results: Among 36 patients, it was determined that the heart rate values of the patients before bowel preparation were higher than the heart rate values after colonoscopy [74.5 (60–108) bpm vs. 68.5 (53–108) bpm, p = 0.021]. The duration of QT interval increased (370.9 ± 27.8 ms vs. 398.7 ± 29.4 ms, p < 0.001) and the iCEB increased from 4.1 ± 0.5 to 4.5 ± 0.6 (p < 0.001), indicating a significant post-procedural risk of ventricular arrhythmias. Conclusions: These findings suggest that routine iCEB assessment post-colonoscopy could identify high-risk patients requiring closer monitoring. [ABSTRACT FROM AUTHOR]

Abstract Background Polyethylene glycol electrolyte solution (PEG-ELS) is the standard for bowel preparation but often suffers from poor patient compliance and tolerability due to its high-volume requirement. This prospective, single-blinded, non-inferiority, randomized control trial aims to investigate the efficacy and safety of a lactulose-based regimen as an alternative for bowel preparation. Methods Two hundred nine patients were randomly allocated to receive either a combination regimen consisting of 133.4 g lactulose in 200 mL, 800 mL carbohydrate-containing clear liquid, 2L additional water, and 5 g simethicone (n = 104) or 3L PEG-ELS with 5 g simethicone (n = 105), both administered in a split-dose format. The primary outcome was the rate of adequate bowel preparation, measured by the Boston bowel preparation score (BBPS). Adequate bowel preparation was defined as a BBPS score of 2 or 3 in all colon segments. Secondary outcomes included the percentage of high-quality bowel preparation (defining as a total BBPS score of 8 or 9), polyp detection rate (defining as the percentage of procedures where at least one polyp was detected), willingness to repeat the bowel preparation, adverse events, and changes in blood glucose and electrolyte levels. Results The rate of adequate bowel preparation (96.2% vs. 97.1%, p = 0.691), the percentage of high-quality preparation (62.5% vs. 66.7%, p = 0.529), average total BBPS scores (p = 0.607), polyp detection rates (66.3% vs. 77.1%, p = 0.083), and tolerability and acceptability outcomes, including satisfaction (p = 0.729) and willingness to repeat preparation (p = 0.744), were not statistically different between the two arms. Adverse events and changes in blood glucose and electrolytes showed no significant differences (all p > 0.05). Conclusion The combination of oral lactulose and carbohydrate-containing clear fluids was non-inferior to 3L PEG-ELS for bowel preparation adequacy and polyp detection, without statistically significant differences in terms of tolerability and safety.

‍Objective‍ ‍To compare the efficacy of 2 L and 3 L polyethylene glycol (PEG) electrolyte solution for bowel preparation in a real-world setting. Methods A real-world, single-center cohort study was conducted on the individuals undergoing colonoscopy in Department of Gastroenterology of Chengdu Third People’s Hospital between May and October 2023. Based on our inclusion and exclusion criteria, they were given 2 L (n=4 684) and 3 L (n=3 700) PEG electrolyte solution for bowel preparation. The primary outcome indicator was the adequacy of bowel preparation by Boston bowel preparation score (BBPS). Secondary outcome indicators included the BBPS score, polyp detection rate (PDR), tolerability, compliance, and incidence of adverse events. Results‍ ‍The adequacy rate of bowel preparation was 94.35% in the 3 L group, significantly higher than that of the 2 L group (91.29%, P

Background: Effective bowel preparation is critical for successful colonoscopy, yet inadequate preparation frequently impairs outcomes. Purpose: This study evaluated personalized nursing care (PNC) against standard care in improving bowel preparation quality for colonoscopy. Methods: A prospective, 2-phase, single-center trial was conducted from July 2023 to July 2024. In phase 1, patients received standard care; in phase 2, personalized preparations were used. Results: Among 1057 patients, PNC significantly improved bowel preparation quality (P < .001). Adequate preparation was achieved by 79% of the PNC group vs 64.3% of the control group. Adherence to bowel preparation was higher in the PNC group (84.0% vs 70.4%, P < .001), as were polyp detection rates (38.2% vs 28.1%, P = .003). Patient satisfaction increased with PNC interventions. Conclusion: PNC enhances colonoscopy preparation, boosting clinical effectiveness and patient satisfaction and advocating for its integration into routine protocols. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Inadequate bowel preparation (IBP) before colonoscopy remains a common problem. This meta- analysis aimed to assess the risk factors associated with IBP. METHODS: We searched multiple databases for studies that assessed risk factors for IBP after adjustment and reported the data as adjusted odds ratios with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted odds ratios for risk factors reported in ≥ 3 studies were constructed. RESULTS: One hundred fifty-four studies with 358,257 participants were included. We analyzed 48 unique risk factors. Sociodemographic predictors of IBP were Medicaid insurance, obesity, current tobacco use, age ≥ 65 years, Black race, low education level, male sex, and unmarried status. Comorbidity-related predictors of IBP were any psychiatric disease, cirrhosis, American Society of Anesthesiologists (ASA) class ≥ 3, poor functional status, constipation, diabetes, previous abdominopelvic surgery, and hematochezia. Medication-related predictors of IBP were tricyclic antidepressants, antidepressants, opioids, nontricyclic antidepressants, and calcium channel blockers. Preparation/procedure-related predictors of IBP were brown liquid rectal effluent, any incomplete bowel preparation (BP) intake, lack of split-dose BP, increased BP-to-defecation interval, any nonadherence to dietary instructions, increased BP-to-colonoscopy interval, any BP intolerance, previous IBP, and inpatient status. Although afternoon colonoscopy was a predictor of IBP, subgroup analysis of prospective studies revealed no significant association. DISCUSSION: Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for IBP. Our findings could help develop a validated prediction model to identify high-risk patients for IBP, improve colonoscopy outcomes, reduce the need for repeat colonoscopies, and reduce associated healthcare costs. [ABSTRACT FROM AUTHOR]

Background and Aim: Colonoscopy plays a crucial role in the early diagnosis and treatment of colorectal cancer. Adequate bowel preparation is essential for clear visualization of the colonic mucosa and lesion detection. However, inadequate bowel preparation is common in patients with constipation, and there is no standardized preparation protocol for these patients. This study aimed to explore the effectiveness and tolerability of a pre‐colonoscopy combination regimen of linaclotide and polyethylene glycol (PEG). Methods: In this prospective, single‐center, randomized controlled trial, 322 participants were divided into two groups: a 3‐L PEG + 870‐μg linaclotide group (administered as a single dose for 3 days) and a 4‐L PEG group. The primary endpoints were the Boston Bowel Preparation Scale (BBPS) score and the rate of adequate and excellent bowel preparation. Secondary endpoints were the rates of detection of colonic adenomas and polyps, cecal intubation rates, colonoscopy time, adverse reactions, patient satisfaction, and physician satisfaction. Results: The study included 319 patients. The 3‐L PEG + linaclotide group showed significantly higher rates of adequate and excellent bowel preparation than the 4‐L PEG group (89.4% vs 73.6% and 37.5% vs 25.3%, respectively; P < 0.05). The mean BBPS score for the right colon in the 3‐L PEG + linaclotide group was significantly higher than that in the 4‐L PEG group. There were no significant between‐group differences regarding the detection rates of colonic polyps and adenomas (44.4% vs 37.7% and 23.1% vs 20.1%, respectively; P > 0.05). There were no significant between‐group differences regarding cecal intubation rates, colonoscopy operation, and withdrawal times. However, patient tolerance and sleep quality were better in the 3‐L PEG + linaclotide group. Conclusion: The combination of 3‐L PEG and 870‐μg linaclotide, because of its lower volume of intake, can be considered as an alternative bowel preparation regimen for constipated patients undergoing colonoscopy, especially for the elderly. [ABSTRACT FROM AUTHOR]

Background and Aims: A low-volume (1 L) polyethylene glycol plus ascorbic acid (PEG-A) solution and an oral sodium sulfate tablet (OST) formulation are recently introduced agents for colonoscopy bowel preparation. This study investigated the efficacy, safety, and tolerability of 1 L PEG-A vs. OST. Methods: This single-center, prospective, randomized, endoscopist-blinded study randomly assigned patients into 2 groups: 1 L PEG-A (group A); and OST (group B). Efficacy of bowel preparation was evaluated using the Boston Bowel Preparation Scale (BBPS). Tolerability and safety were investigated with a standardized questionnaire. Results: A total of 174 patients were included in the final analysis (group A, n = 92; group B, n = 82). Successful bowel preparation was achieved in 91.3% and 95.1% of patients in groups A and B, respectively (p = 0.324). Overall mean satisfaction with bowel preparation was greater among those in group B vs. those in group A (8.2 ± 1.7 vs. 6.8 ± 2.0, respectively; p < 0.001). Although abdominal distension was less common in group A than group B (3/92 [3.3%] vs. 9/82 [11.0%], respectively; p = 0.045), overall adverse events developed similarly in both groups (27/92 [29.3%] vs. 21/82 [25.6%], p = 0.583). In subgroup analysis of older patients (≥65 years of age), efficacy, overall satisfaction, and safety profiles were not different between groups A and B. Conclusions: Both 1 L PEG-A and OST demonstrated efficacy, tolerability, and safety for colonoscopy bowel preparation. OST was slightly better tolerated, whereas 1 L PEG-A resulted in less abdominal distension. Both agents were effective and safe in older patients. [ABSTRACT FROM AUTHOR]

Objectives: Colonoscopy (CS) is an important screening method for the early detection and removal of precancerous lesions. The stool state during bowel preparation (BP) should be properly evaluated to perform CS with sufficient quality. This study aimed to develop a smartphone application (app) with an artificial intelligence (AI) model for stool state evaluation during BP and to investigate whether the use of the app could maintain an adequate quality of CS. Methods: First, stool images were collected in our hospital to develop the AI model and were categorized into grade 1 (solid or muddy stools), grade 2 (cloudy watery stools), and grade 3 (clear watery stools). The AI model for stool state evaluation (grades 1–3) was constructed and internally verified using the cross‐validation method. Second, a prospective study was conducted on the quality of CS using the app in our hospital. The primary end‐point was the proportion of patients who achieved Boston Bowel Preparation Scale (BBPS) ≥6 among those who successfully used the app. Results: The AI model showed mean accuracy rates of 90.2%, 65.0%, and 89.3 for grades 1, 2, and 3, respectively. The prospective study enrolled 106 patients and revealed that 99.0% (95% confidence interval 95.3–99.9%) of patients achieved a BBPS ≥6. Conclusion: The proportion of patients with BBPS ≥6 during CS using the developed app exceeded the set expected value. This app could contribute to the performance of high‐quality CS in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Faecal calprotectin (FC) is an easily applicable faecal surrogate marker of intestinal inflammation; it has provided a new means for objectively assessing disease activity in patients with various bowel diseases. In this study, the authors assessed levels of FC before colonoscopy preparation, during bowel cleansing and 1 week after colonoscopy. Methods: This cross-sectional study was conducted on 58 individuals referred to Razi Hospital, Rasht, Iran, for colonoscopy between 2021 and 2022. For all individuals, stool sampling was repeated three times before colonoscopy, during bowel preparation and 1 week after colonoscopy. All demographical and clinical data were collected through a questionnaire. FC results, colonoscopy and pathology findings were also recorded. Results: The mean age of the participants was 48.22±11.69 years and approximately 62.1% were female. There was no statistically significant difference between the average levels of FC before colonoscopy preparation, during bowel cleansing and 1 week after colonoscopy (P>0.05). The average amount of FC at different time points was not significantly different in patients with abnormal histopathological results compared to individuals with normal findings (P>0.05). Conclusions: The study findings suggest that bowel cleansing and colonoscopy do not significantly alter FC levels. [ABSTRACT FROM AUTHOR]

Background: Three liters of polyethylene glycol administered in a split dose is a commonly recommended regimen for bowel preparation before colonoscopy. Objectives: The aim of this study was to compare the quality and tolerability of low-dose (2 L) polyethylene glycol combined with linaclotide (2 L+L) versus the 3 L polyethylene glycol (PEG) bowel preparation regimen. Design: A noninferiority, prospective, multicenter, randomized controlled trial. Methods: In this noninferiority, prospective, multicenter, randomized controlled study, patients scheduled for colonoscopy were enrolled and randomized to receive a 3 L PEG or 2L PEG+L regimen. The quality of bowel preparation and patients' discomfort was assessed. Results: Over 12 months, 458 patients were randomized into 3 L PEG and 2 L+L groups. The primary endpoints showed that the 2 L+L regimen was superior to the 3L PEG regimen in overall bowel cleansing scores (Ottawa Bowel Preparation Scale: 3.3 ± 2.1 vs 3.7 ± 2.1, p = 0.021), but no significant difference in adequate bowel preparation rate between the two groups according to the OBPS score (97% vs 97.4%, p = 0.791). Before colonoscopy, patients in the 2 L +L regimen group had lower bloating scores (0.5 (0, 2) vs 1 (0, 3), p = 0.013), discomfort scores (1 (0, 2) vs 1 (0, 3), p = 0.006), and intolerability scores (1 (0, 3) vs 2 (0, 4), p = 0.016) than did those in the 3L PEG group. Conclusion: Two liters of polyethylene glycol combined with linaclotide may be an alternative regimen to 3 L of PEG taken in split doses for bowel preparation before colonoscopy. Trial registration: ChiCTR2100041992. Plain language summary: Improvement in bowel preparation efficacy and patients' discomfort after polyethylene glycol (2 L) combined with linaclotide. The commonly recommended intestinal cleanser regimen is 3 L of polyethylene glycol, which achieves cleansing of the intestinal segments but may give discomfort to the patients. We have conducted a noninferiority, prospective, multicenter, randomized controlled trial to compare 2 L polyethylene glycol+ linaclotide and 3 L polyethylene glycol. The results showed that similar patients' percentage had adequate bowel preparation rate in two groups according to the OBPS score. However, the 2 L+L regimen was superior to the 3 L PEG regimen in overall bowel cleansing scores and patients' discomfort. Trial registration number: ChiCTR2100041992. [ABSTRACT FROM AUTHOR]

Background/objectives:To date, no studies have evaluated Chat Generative Pre-Trained Transformer (ChatGPT) as a large language model chatbot in optical applications for digestive endoscopy images. This study aimed to weigh the performance of ChatGPT-4 in assessing bowel preparation (BP) quality for colonoscopy. Methods: ChatGPT-4 analysed 663 anonymised endoscopic images, scoring each according to the Boston BP scale (BBPS). Expert physicians scored the same images subsequently. Results: ChatGPT-4 deemed 369 frames (62.9%) to be adequately prepared (i.e., BBPS > 1) compared to 524 frames (89.3%) assessed by human assessors. The agreement was slight (κ: 0.099, p = 0.0001). The raw human BBPS score was higher at 3 (2–3) than that of ChatGPT-4 at 2 (1–3), demonstrating moderate concordance (W: 0.554, p = 0.036). Conclusions: ChatGPT-4 demonstrates some potential in assessing BP on colonoscopy images, but further refinement is still needed. [ABSTRACT FROM AUTHOR]

Several randomized clinical trials comparing different bowel preparations (BP) have shown similar efficacy; however, there is a lack of real-world studies on this topic. This study aims to identify the most effective BP regimen in a real-world setting and any predictors of inadequate BP. A retrospective single-center study was conducted over 14 months at an academic hospital including outpatient colonoscopies in which adult patients did not teach on how to perform BP before colonoscopy. Colonoscopies with 1L-PEG, 2L-PEG and picosulphate mixtures were considered. A multivariable analysis for factors associated to poor BP was fitted. Overall, 1779 patients (51 %F, 60±14) years were included. The 1L-PEG regimen provided a higher rate of BP adequacy at multivariate analysis (adjusted OR 2.30, 95 %CI 1.67–3.16, p < 0.001) and was associated with higher median Boston Bowel Preparation Scale score (p < 0.001), higher rate of right-colon cleansing (p < 0.001) and exam completion (p = 0.04). Furthermore, we identified male sex, history of constipation, active smoking, previous pelvic surgery, concomitant psychiatric/neurological or chronic kidney diseases as predictors of inadequate BP. This is the largest real-world study comparing 1L-PEG to other BP regimens. Our results suggest 1L-PEG provides better BP in a non-controlled setting, improving clinical practice quality and minimizing the need for repeated colonoscopies and saving healthcare resources. [ABSTRACT FROM AUTHOR]

Introduction: Colonoscopy is an important diagnostic tool for colonic disease and its efficacy and safety have been correlated with adequate bowel preparation. This study compared the efficacy and tolerability of single-dose and split-dose sodium picosulfate lavage as a colon cleansing agent for colonoscopy preparation. Methods: This randomized clinical trial was conducted at the Department of Gastroenterology in Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from June 2021 to May 2022.A total of 110 patients were selected by randomized sampling technique who underwent elective colonoscopy and were divided into split-dose (n=57) and single-dose (n=53) laxative groups. Bowel preparation was assessed by the Ottawa Bowel Preparation Scale (OBPS) and data were analyzed by SPSS 24.0. Result: The mean age of the patients was 47.4±17.7(SD) years in split-dose and 47.6±15.9 (SD) years in single-dose group. Both groups were statistically similar in terms of socio-demographic profile, medical history, clinical manifestation, and indication of colonoscopy (p>0.05). The mean of total OBPS score (4.39±2.0 vs 5.56±2.2, p=0.004) and caecal intubation time (6.60±3 vs 7.74±2.5, p=0.035) was lower significantly in split-dose than the single-dose group. However, colonoscopy findings, adverse events, and patient compliance were similar between groups (p>0.05). Conclusion: Split-dose is superior to single-dose bowel laxatives for colonoscopy preparation in terms of better mucosal cleanliness and lower caecal intubation time. However, further randomized controlled trial is recommended. [ABSTRACT FROM AUTHOR]

Background: The fecal immunochemical test (FIT) is used for colorectal cancer (CRC) screening. Patients on antithrombotic drugs (ATs) are often screened for CRC, but the effect of ATs on FIT results is controversial. Methods: We divided individuals with FIT‐positive results into two groups, patients treated with and without ATs, and retrospectively compared invasive CRC rates, advanced neoplasia detection rates (ANDRs), adenoma detection rates (ADRs), and polyp detection rates (PDRs) between the two groups. We evaluated the factors influencing the FIT positive predictive value (PPV) using propensity matching, adjusting for age, sex, and bowel preparation. Results: We enrolled 2327 individuals (54.9% male; mean age, 66.7 ± 12.7 years). We grouped 463 individuals into the AT user group and 1864 into the nonuser group. Patients in the AT user group were significantly older and more likely to be male. After propensity score matching for age, sex, and Boston bowel preparation scale, the ADR and PDR in the AT user group were significantly lower than those in the nonuser group. Univariate logistic analysis revealed that multiple AT use (odds ratio [OR]:.39, p < 0.001) had the lowest OR for FIT PPV, followed by age‐ and sex‐adjusted factors for the ADR and any AT use (OR:.67, p = 0.0007). No significant factors related to AT use were observed among age‐adjusted predictive factors for invasive CRC, but warfarin use was a borderline significant positive predictive factor (OR: 2.23, p = 0.059). Conclusion: AT use may not affect the PPV for detecting invasive CRC in patients with positive FIT results, but warfarin may have an impact. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Adequate bowel preparation is paramount for a high-quality screening colonoscopy. Despite the importance of adequate bowel preparation, there is a lack of large studies that associated the degree of bowel preparation with long-term colorectal cancer outcomes in screening patients. METHODS: In a large population-based screening program database in Austria, quality of bowel preparation was estimated according to the Aronchick Scale by the endoscopist (excellent, good, fair, poor, and inadequate bowel preparation). We used logistic regression to assess the influence of bowel preparation on the detection of different polyp types and the interphysician variation in bowel preparation scoring. Time-to-event analyses were performed to investigate the association of bowel preparation with postcolonoscopy colorectal cancer (PCCRC) death. RESULTS: A total of 335,466 colonoscopies between January 2012 and follow-up until December 2022 were eligible for the analyses. As compared with excellent bowel preparation, adenoma detection was not significantly lower for good bowel preparation (odds ratio 1.01, 95% confidence interval [CI] 0.9971-1.0329, P 5 0.1023); however, adenoma detection was significantly lower in fair bowel preparation (odds ratio 0.97, 95% CI 0.9408-0.9939, P 5 0.0166). Individuals who had fair or lower bowel preparation at screening colonoscopy had significantly higher hazards for PCCRC death (hazard ratio for fair bowel preparation 2.56, 95% CI 1.67-3.94, P < 0.001). DISCUSSION: Fair bowel preparation on the Aronchick Scale was not only associated with a lower adenoma detection probability but also with increased risk of PCCRC death. Efforts should be made to increase bowel cleansing above fair scores. [ABSTRACT FROM AUTHOR]

Background and Aim: The compliance and timeliness of oral laxatives have always been the key factors restricting bowel preparation (BP). We have constructed a novel enhanced‐educational content and process based on social software (SS) for BP to optimize these issues. Methods: A multicenter, prospective, randomized controlled study was conducted at 13 hospitals in China from December 2019 to December 2020. A total of 1774 enrollees received standard instructions for BP and were randomly assigned (1:1) to the SS group (SSG) that received a smartphone‐based enhanced‐education strategy starting 4 h before colonoscopy or the control group (CG). Results: A total of 3034 consecutive outpatient colonoscopy patients were assessed for eligibility, and 1774 were enrolled and randomly assigned. Ultimately, data from 1747 (SSG vs CG: 875 vs 872) enrollees were collected. The BP adequacy rate was 92.22% (95% CI: 90.46–93.98) in the SSG vs 88.05% (95% CI: 85.91–90.18) in the CG (P = 0.005), and the total Boston Bowel Preparation Scale scores (6.89 ± 1.15 vs 6.67 ± 1.15, P < 0.001) of those in the SSG were significantly higher than those in the CG. The average number of polyps detected in the SSG was considerably higher than that in the CG (0.84 ± 2.00 vs 0.53 ± 1.19, P = 0.037), and the average diameter of the polyps was significantly lower than that of the control group (4.0 ± 2.5 vs 4.9 ± 3.7, P < 0.001). Conclusions: This SS‐enhanced education strategy can improve the BP adequacy rate and increase the average number of polyps detected, especially those of small diameter. [ABSTRACT FROM AUTHOR]

In the field of colonoscopy preparation, the focus is on improving patient experience, optimizing bowel cleansing efficacy, and exploring innovative technologies. The ongoing advancements made colonoscopy preparation more tolerable, effective, and accessible for patients, ultimately improving the overall quality of the procedure. Current evidence supports low volume preparations and split dose regimen in most cases. Adding simethicone to PEG might bring some advantages in terms of better visibility and tolerability. In this mini review we present the main evidence regarding the low volume PEG/citrate/simethicone colonoscopy preparation solution. [ABSTRACT FROM AUTHOR]

Background and Aims: Information on effective bowel preparation (BP) methods for patients with constipation is limited. We recently reported the efficacy of 1 L polyethylene glycol plus ascorbic acid (PEG-Asc) combined with senna for BP; however, this regimen was insufficient in patients with constipation. We hypothesized that the addition of linaclotide, which is approved for the treatment of chronic constipation, to 1 L PEG-Asc would yield results superior to those of senna in patients with constipation. Methods: This was a retrospective, single-center study that included outpatients with constipation who underwent BP prior to colonoscopy between March and December 2019 (receiving 1 L PEG-Asc with 24 mg senna) and between January and October 2020 (receiving 1 L PEG-Asc with 500 mg linaclotide). Results: A total of 543 patients with constipation were included, of whom 269 received linaclotide and 274 received senna. The rate of inadequate BP was significantly lower (11% vs 20%, p < 0.01) and the adenoma detection rate was significantly higher (54% vs 45%, p = 0.04) in the linaclotide group than in the senna group. Multivariate analysis revealed that the linaclotide regimen significantly reduced the risk of inadequate BP (odds ratio = 0.36, 95% confidence interval = 0.21–0.60, p < 0.01). Conclusions: The linaclotide regimen significantly increased BP efficacy and the adenoma detection rate compared with the senna regimen without reducing tolerability and is therefore a promising new option for BP in patients with constipation. [ABSTRACT FROM AUTHOR]

Mechanical bowel preparation (MBP) is essential for visualisation of the colon during colonoscopy. Previous studies have identified changes in gut microbiota composition after MBP and colonoscopy. Considering the gut microbiota is increasingly implicated in psychiatry, we explored the potential impact of this intervention on mood and the microbiota–gut–brain axis. We conducted a pre–post intervention study in adults, with timepoints of one week before and one month after MBP and colonoscopy. Our primary outcome was change in average Hospital Anxiety and Depression Scale depression sub-scores. We examined changes in average anxiety, stress, and quality of life scores and gut microbiota composition using 16S rRNA sequencing. We further explored associations between changes in depressive symptoms and gut microbiota and conducted post hoc analyses to explore potential effect modifiers. Average depressive symptom scores decreased one month post-procedure compared to baseline (n = 59; adjusted β = −0.64; 95%CI: −1.18, −0.11). Irritable bowel syndrome (IBS) appeared to moderate this relationship (β = 1.78; 95%CI: 0.292, 3.26); depressive symptoms increased in those with, and decreased in those without, IBS. Reduced alpha diversity, modest effects on beta-diversity, and increases in health-associated genera were observed one month post-procedure. Increases in the CLR-transformed abundances of Ruminococcaceae UCG-009 were associated with improvements in depressive symptoms. There is preliminary evidence of a potential mental health effect of MBP and colonoscopy, particularly for those with IBS, which may be associated with changes to the gut microbiota. Further research is required to confirm these findings and their clinical relevance. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Bowel preparation can directly affect the final outcome of a colonoscopy. However, limited studies have been conducted regarding the effect of probiotics on intestinal preparation. Thus, the present study aims to investigate the effect of Lactobacillus reuteri probiotics in the bowel preparation regimen of children who are candidates for colonoscopy. Methods and Materials In this double‐blind, placebo‐controlled, randomized clinical trial, 84 colonoscopy candidate pediatric patients were enrolled. Patients were divided into two equal groups of 42 individuals. One group of patients underwent the bisacodyl, polyethylene glycol regimen 48 h before colonoscopy, as along with a placebo. The other group was administered L. reuteri 10 days before colonoscopy and also received bisacodyl and polyethylene glycol 48 h before the procedure. Then, the bowel preparation of the patients was assessed using the Boston Bowel Preparation Scale (BBPS). Results The mean age of patients in the placebo and probiotic groups was 94.1 ± 43.8 and 111.2 ± 48.8 months, respectively (p = 0.10). The preparation of the left colon was not significantly different between the placebo and probiotic groups (p = 0.075). The effect of L. reuteri probiotic on the preparation of the right colon was excellent in 18 patients (42.86%) and good in 17 patients (40.47%). The preparation of the right colon was significantly different between the placebo and probiotic groups (p = 0.007). Based on the results, there was a significant association between the consumption of L. reuteri and placebo in the preparation of the transverse colon (p = 0.015). Conclusion Probiotic pretreatment as part of bowel preparation significantly improves visualization of the colonic mucosa during colonoscopy.

Background and aim: The ideal bowel cleansing program still needs to be explored. The aim was to compare the bowel cleansing effect and patient tolerance of low-dose polyethylene glycol (PEG) combined with different doses of linaclotide in fractionated bowel preparation. Methods: The subjects were randomly assigned to the 3LPEG group, 2LPEG + 2L group, or 2LPEG + L group. The primary outcome was to use the Ottawa Bowel Preparation Scale (OBPS) to evaluate the efficacy of bowel cleansing, and the secondary outcomes were the detection rate of adenomas and polyps, adverse reactions, tolerance, and defecation dynamics; subsets of patients with chronic constipation and irritable bowel syndrome were also analyzed. Results: A total of 753 patients were randomly assigned. In ITT analysis, the success of preparation of the 2LPEG + 2L group was better than that of the 2LPEG + L group or the 3LPEG group (92.0% vs. 82.3% vs. 82.1%; P = 0.002). Compared with the 3LPEG group, the 2LPEG + L group showed similar but non-inferior results (82.3% vs. 82.1%, P > 0.05). The 2LPEG + 2L group was similar to the 2LPEG + L group in terms of adverse reaction, tolerance, willingness to reuse, and sleep quality, but both were superior to the 3LPEG group. In a subgroup analysis of chronic constipation, the 2LPEG + 2L group had the best cleansing effect on the right colon and mid colon, while in the subgroup analysis of irritable bowel syndrome, the tolerance was better in the 2LPEG + 2L group and the 2LPEG + L group than the 3LPEG group. Conclusions: 2LPEG + 2L is a feasible bowel preparation regimen. [ABSTRACT FROM AUTHOR]

There is robust evidence to indicate a strong correlation between the bowel preparation status and adenoma detection rate (ADR), which directly impacts the incidence and mortality rate of postcolonoscopy colorectal cancer. Therefore, improving bowel preparation has been of increasing interest. In Japan, commercially available bowel preparation agents include polyethylene glycol, oral sodium sulfate, sodium picosulfate‐magnesium citrate, magnesium citrate, and oral sodium phosphate; each has its own strengths and limitations. The timing of administration can also influence the efficacy of bowel preparation and patient tolerability. Furthermore, meta‐analyses have suggested predictive factors for inadequate bowel preparation. A detailed understanding of these factors could contribute to reducing the need for repeat colonoscopy within 1 year, as recommended for patients with inadequate bowel preparation. Recent advancements, such as oral sulfate tablets, present promising alternatives with higher patient satisfaction and ADRs than traditional methods. Achieving optimal bowel preparation requires enhanced instructions, individualized regimens, and a comprehensive understanding of patient backgrounds and the characteristics of various bowel preparation agents. This article provides a concise overview of the current status and advancements in bowel preparation for enhancing the quality and safety of colonoscopy. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy of oral Danning tablets for bowel preparation for colonoscopy in diabetes mellitus patients. Methods A study was conducted from November 2022 to May 2024, 100 type 2 diabetic patients (aged≥30 years) admitted to endocrinology department in our hospital were selected and scheduled for colonoscopy as research subjects. These patients were randomly divided into two groups: ① A control group (n=50), received 68.56 g of polyethylene glycol electrolyte powder 10 hours before the colonoscopy and an additional 137.12 g six hours before the procedure. ② An experimental group (n=50), in addition to the bowel preparation regimen of the control group, orally took Danning tablets three times daily, five tablets each time, starting two days before the colonoscopy. Results The experimental group had a BBPS score of (7.44±1.03), which was higher than the control group’s BBPS score of (5.58±1.98), P<0.001. In the experimental group, 96% of the bowel preparations were rated as excellent or good (BBPS score≥6), significantly higher than the 58% in the control group (P<0.001). Conclusion In diabetic patients undergoing colonoscopy, oral administration of Danning tablets during bowel preparation could improve bowel cleanliness and significantly enhance the quality of bowel preparation. [ABSTRACT FROM AUTHOR]

Background and aims: Adequate bowel preparation (BP) is crucial for the diagnosis of colorectal diseases. Identifying patients at risk of inadequate BP allows for targeted interventions and improved outcomes. We aimed to develop a model for predicting inadequate BP based on preparation-related factors. Methods: Adult outpatients scheduled for colonoscopy between May 2022 and October 2022 were enrolled. One set (N = 913) was used to develop and internally validate the predictive model. The primary predictive model was displayed as a nomogram and then modified into a novel scoring system, which was externally validated in an independent set (N = 177). Inadequate BP was defined as a Boston Bowel Preparedness Scale (BBPS) score of less than 2 for any colonic segment. The model was evaluated by the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA). Results: Independent factors included in the prediction model were stool frequency ≤ 5 (15 points), preparation-to-colonoscopy interval ≥ 5 h (15 points), incomplete dosage (100 points), non-split dose (90 points), unrestricted diet (88 points), no additional water intake (15 points), and last stool appearance as an opaque liquid (0–80 points). The training set exhibited the following performance metrics for identifying BP failure: area under the curve (AUC) of 0.818, accuracy (ACC) of 0.818, positive likelihood ratio (PLR) of 2.397, negative likelihood ratio (NLR) of 0.162, positive predictive value (PPV) of 0.850, and negative predictive value (NPV) of 0.723. In the internal validation set, these metrics were 0.747, 0.776, 2.099, 0.278, 0.866, and 0.538, respectively. The external validation set showed values of 0.728, 0.757, 2.10, 0.247, 0.782, and 0.704, respectively, indicating strong discriminative ability. Calibration curves demonstrated close agreement, and DCA indicated superior clinical benefits at a threshold probability of 0.73 in the training cohort and 0.75 in the validation cohort for this model. Conclusions: This novel scoring system was developed from a prospective study and externally validated in an independent set based on 7 easily accessible variables, demonstrating robust performance in predicting inadequate BP. [ABSTRACT FROM AUTHOR]

Background: Effective colonoscopy is considered accurate and safe when there is good quality bowel preparation. In this study, we aimed to evaluate the effectiveness of an abdominal vibration stimulation program on the quality of bowel preparation in patients undergoing screening and surveillance colonoscopy. Design: This study was a single-centre, randomised, controlled trial. Methods: The participants consisted of 72 patients who received elective in-patient screening and surveillance colonoscopy at a tertiary hospital in central Thailand. Patients were randomly assigned to two groups: an experimental group (n=38) and a control group (n=34). Both groups received the same bowel cleansing regimen of 90 ml split-dose sodium phosphate solution. The experimental group received the abdominal vibration stimulation. General surgeons, who were blinded to which group participants were assigned, evaluated the bowel preparation of all participants using the Boston Bowel Preparation Scale (BBPS). Results: The experimental group showed a statistically significant higher mean score on the BBPS than the control group (p=0.049). The BBPS score for the colon and rectum as a whole of the experimental group was 7.21 ± 1.80 and for the control group was 6.29 ± 2.08. Conclusion: The addition of abdominal vibration stimulation can improve the quality of bowel preparation in patients undergoing screening and surveillance colonoscopy. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests that the human vermiform appendix is not a vestigial organ but rather an immunological organ of biological relevance. It is hypothesised that the appendix acts as a bacterial 'safe house' for commensal gut bacteria and facilitates re-inoculation of the colon after disruption through the release of biofilms. To date, no studies have attempted to explore this potential mechanistic function of the appendix. We conducted a pre-post intervention study in adults (n = 59) exploring re-establishment of the gut microbiota in those with and without an appendix after colonic disruption via bowel preparation and colonoscopy. Gut microbiota composition was measured one week before and one month after bowel preparation and colonoscopy using 16S rRNA sequencing. We observed between group differences in gut microbiota composition between those with (n = 45) and without (n = 13) an appendix at baseline. These differences were no longer evident one-month post-procedure, suggesting that this procedure may have 'reset' any potential appendix-related differences between groups. Both groups experienced reductions in gut microbiota richness and shifts in beta diversity post-procedure, with greater changes in those without an appendix, and there were five bacterial genera whose re-establishment post-procedure appeared to be moderated by appendicectomy status. This small experimental study provides preliminary evidence of a potential differential re-establishment of the gut microbiota after disruption in those with and without an appendix, warranting further investigation into the potential role of the appendix as a microbial safe house. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare oral sulfate solution (OSS) with polyethylene glycol (PEG) for bowel preparation before colonoscopy. Methods: A literature search was performed on PubMed, Ovid, and Cochrane Databases for randomized clinical trials (RCT) comparing OSS with PEG for bowel preparation before colonoscopy. The last search was performed on 22 August 2023. The primary outcome was the quality of bowel preparation. The outcomes were compared by meta-analysis and trial sequential analysis (TSA). Results: A total of 14 RCTs with 4526 patients were included. OSS was comparable with PEG regarding adequate bowel preparation [P = 0.16, odds ratio (OR) = 1.19, 95% confidence interval (CI) [0.93, 1.51], I2 = 0%]. However, OSS showed obvious priority in excellent bowel preparation (P < 0.001, OR = 1.62, 95% CI [1.27, 2.05], I2 = 0%) and total Boston bowel preparation scale (BBPS) [P = 0.02, weighted mean difference (WMD) = 0.27, 95% CI [0.05, 0.50], I2 = 84%]. Additionally, the detection rate of polyps (P = 0.001, OR = 1.44, 95% CI [1.15, 1.80], I2 = 0%) and adenoma (P = 0.007, OR = 1.22, 95% CI [1.06, 1.42], I2 = 0%) was significantly higher in the OSS group. The two groups showed comparable incidence of adverse events except for a higher incidence of dizziness (P = 0.02, OR = 1.74, 95% CI [1.08, 2.83], I2 = 11%) was indicated in the OSS group. Moreover, OSS was associated with a higher satisfaction score (P = 0.02, WMD = 0.62, 95% CI [0.09, 1.15], I2 = 70%). In the TSA, the cumulative Z-curve crossed both the conventional boundary and trial sequential monitoring boundary and the required information size has been reached for excellent bowel preparation and total BBPS. Conclusion: The current data demonstrated that OSS was associated with better quality of bowel preparation. More clinical trials are still needed to confirm other outcomes. [ABSTRACT FROM AUTHOR]

Long-time follow-up of sigmoidoscopy screening trials has shown reduced incidence and mortality of colorectal cancer (CRC), but inadequate bowel cleansing may hamper efficacy. The aim of this study was to assess the impact of bowel cleansing quality in sigmoidoscopy screening. Individuals 50 to 74 years old who had a screening sigmoidoscopy in a population-based Norwegian, randomized trial between 2012 and 2019, were included in this cross-sectional study. The bowel cleansing quality was categorised as excellent, good, partly poor, or poor. The effect of bowel cleansing quality on adenoma detection rate (ADR) and referral to colonoscopy was evaluated by fitting multivariable logistic regression models. 35,710 individuals were included. The bowel cleansing at sigmoidoscopy was excellent in 20,934 (58.6%) individuals, good in 6580 (18.4%), partly poor in 7097 (19.9%) and poor in 1099 (3.1%). The corresponding ADRs were 17.0%, 16.6%, 14.5%, and 13.0%. Compared to participants with excellent bowel cleansing, those with poor bowel cleansing had an odds ratio for adenoma detection of 0.66 (95% confidence interval 0.55–0.79). We found substantial differences in the assessment of bowel cleansing quality among endoscopists. Inadequate bowel cleansing reduces the efficacy of sigmoidoscopy screening, by lowering ADR. A validated rating scale and improved bowel preparation are needed to make sigmoidoscopy an appropriate screening method. Trial registration Clinicaltrials.gov (NCT 01538550) [ABSTRACT FROM AUTHOR]

Background and Aim: Adequate bowel preparation is necessary for optimal colonoscopy. Inadequate bowel preparation results in increased costs and imprecise colonoscopy results. This study aims to determine the incidence and risk factors of inadequate bowel preparation. Methods: In this study, 604 consecutive patients were observed prospectively who underwent colonoscopy examination. The patient's clinical and demographic data were obtained on the day of the procedure. Bowel preparation was evaluated by Boston Bowel Preparation Scale (BBPS) and was divided into two groups; adequate and inadequate. Univariate and multivariate analyses were performed. Results: Inadequate bowel preparation incidence was 17.9%. In the univariate analysis, education level (P value = 0.009), body mass index (P value = 0.03), admission type (P value = 0.038), previous history of colonoscopy (P value = 0.03), color and consistency of the last feces (P value = 0.03), diabetes (P value = 0.004), and smoking (P value = 0.03) were significantly related with the incidence of inadequate bowel preparation. While ischemic heart disease (IHD) decreased the level of inadequate bowel preparation (P value = 0.047). Multivariate analysis showed that diabetes mellitus (odds ratio [OR] = 2.18), smoking (OR = 2.10), inpatient status of admission type (OR = 3.32), last stool that was non‐watery (OR = 1.60), and ischemic heart disease (OR = 0.032) were independent factors associated with inadequate bowel preparation. Conclusion: Diabetic patients, smokers, inpatients and who defecated a non‐watery and colory stool as the last defecation are at risk of inadequate bowel preparation and need more potent regimens. It is important to inform patients about preventable factors that affect bowel preparation to improve their preparation outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Shankhaprakshalana (SP) is a yogic method aiming to cleanse the bowel. It involves the use of warm saline water and a combination of five asanas. This study was designed to assess the effectiveness and safety of bowel preparation by SP. Methods: This is a retrospective observational study of prospectively collected data. Patients planned for colonoscopy were screened and enrolled to undergo bowel preparation by SP on the day of the colonoscopy. Patients having comorbid conditions, poor performance status, suspected or previously diagnosed intestinal stricture and past history of major abdominal surgery and those unable to perform asanas of SP were excluded. A low-fiber diet was advised for one day before the colonoscopy. Patients were advised to drink 400 mL of lukewarm saline water followed by five asanas (exercises) of SP, each done eight times dynamically and sequentially. After completing six such cycles, patients underwent colonoscopy. Boston Bowel Preparation Scale (BBPS) score was used to assess the quality of bowel preparation. Results: Total 238 patients were included. The major indications for colonoscopy were abdominal pain (35.3%), hematochezia (23.9%), diarrhea (20.2%), constipation (10.9%) and anemia (9.7%). The mean age was 37.7 (± 12) years. The mean BBPS was 8 (± 1.2). Bowel preparation was inadequate (BBPS < 6) in only two patients. Mean segmental BBPS for the three segments of the colon (right, transverse and left) was 2.6 (± 0.5), 2.7 (± 0.4) and 2.6 (± 0.7), respectively. Minor adverse events (nausea, abdominal pain, vomiting, giddiness and bloating) were noted in 10 participants (4.2%), which did not require hospitalization. Bowel preparation was completed in 133 (± 35) minutes. Conclusion: Shankhaprakshalana is an effective and safe method to achieve adequate bowel preparation before colonoscopy. Since this is a single-center and retrospective study, future multi-centric, prospective studies comparing it with the standard bowel preparation regimens are warranted. [ABSTRACT FROM AUTHOR]

Providing patients with accurate and organized information about colonoscopy, while reducing anxiety, is critical to the procedure's success. This study evaluated the impact of an immersive 360° virtual reality (VR)-based educational intervention for first-time adult colonoscopy patients regarding anxiety, attitudes, knowledge, compliance with bowel preparation, and bowel cleanliness. A quasi-experimental design with a non-equivalent control group and non-synchronized pretest–post-test clinical trial was conducted with 40 patients in the experimental group and 40 in the control group. The 360° VR intervention included two sessions: precautions before colonoscopy and the colonoscopy process. The control group received education through individual verbal explanations with written materials. The findings indicated that the VR intervention significantly improved patients' colonoscopy-related anxiety, attitudes, adherence to bowel preparation instructions, and bowel cleanliness. Utilizing 360° VR as an educational tool has the potential to enhance the effectiveness of educational programs by providing realistic information and engaging patients. These findings suggest that 360° VR has the capacity to enhance screening rates and clinical outcomes by reducing negative perceptions associated with colonoscopy. Furthermore, the application of this method can extend to diverse diagnostic testing-related nursing situations in clinical settings. [ABSTRACT FROM AUTHOR]