Alaa Alghamry1,2, Sureshkumar K Ponnuswamy1, Aditya Agarwal1, Hadi Moattar1, Stephanie T Yerkovich2,3, Ann E Vandeleur1, James Thomas1,2, John Croese1,4, Tony Rahman1,4, Ruth Hodgson1,2. 1. Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia. 2. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. 3. QLD Lung Transplant Service, The Prince Charles Hospital, Chermside, Queensland, Australia. 4. Division of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
Abstract
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 pH 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 pH was found (r = -0.017, P = 0.62 and r = -0.030, P = 0.47, respectively). RGV and pH 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 pH as those achieved by more prolonged fasting, with no increased risk of aspiration even in patients perceived to be at high risk.
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 pH 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 pH was found (r = -0.017, P = 0.62 and r = -0.030, P = 0.47, respectively). RGV and pH 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 pH as those achieved by more prolonged fasting, with no increased risk of aspiration even in patients perceived to be at high risk.
Authors: S M Green; P L Leroy; M G Roback; M G Irwin; G Andolfatto; F E Babl; E Barbi; L R Costa; A Absalom; D W Carlson; B S Krauss; J Roelofse; V M Yuen; E Alcaino; P S Costa; K P Mason Journal: Anaesthesia Date: 2019-12-02 Impact factor: 6.955
Authors: Giuseppe Vanella; Cesare Hassan; Mario De Bellis; Maxemiliano Giardini; Enrico Grasso; Francesco Laterza; Ottaviano Tarantino; Emilio Di Giulio Journal: Endosc Int Open Date: 2019-10-22