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Current Drug Metabolism

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ISSN (Print): 1389-2002
ISSN (Online): 1875-5453

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Review Article

New Ultra Low Volume Bowel Preparation and Overview of Existing Bowel Preparations

Author(s): Hein Htet* and Jonathan Segal

Volume 21, Issue 11, 2020

Page: [844 - 849] Pages: 6

DOI: 10.2174/1567201817666200810112136

Price: $65

Abstract

Background: Adequate bowel cleansing is essential in achieving a good quality colonoscopy. However, one of the barriers to achieving high-quality bowel cleansing is the patient's tolerability. Different bowel preparations have been developed to improve tolerability while maintaining adequate bowel cleansing.

Objectives: We aim to explore the pros and cons of commonly used bowel preparations, particularly highlighting the new ultra-low volume bowel preparation.

Methods: Extensive literature search was carried out on various databases to evaluate the effectiveness and side effects of different bowel cleansing agents, including findings of recent clinical trials on ultra-low bowel preparation.

Results: Polyethylene glycol (PEG) has been commonly used as a bowel prep. Due to its high volume required to ingest to achieve an adequate effect, it has been combined with various adjuncts to reduce the volume to make it more tolerable. Magnesium and phosphate-based preps can achieve low volume, but they can be associated with multiple side effects, mainly electrolyte disturbances. Ultra low volume prep (NER1006) was achieved by combing PEG with ascorbic acid, and its efficacy and side effects were demonstrated in three noninferiority studies.

Conclusion: It is important to consider patient preferences, co-morbidities and tolerability, and efficacy and side effect profiles when choosing bowel prep for patients undergoing colonoscopy. New ultra-low bowel prep showed promising results in initial clinical trials, but further real-world post-marketing data will inform its value in clinical practice.

Keywords: Bowel prep, ultra-low volume, NER1006, PEG, magnesium-based prep, phosphate-based prep.

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[1]
Rex, D.K.; Boland, C.R.; Dominitz, J.A.; Giardiello, F.M.; Johnson, D.A.; Kaltenbach, T.; Levin, T.R.; Lieberman, D.; Robertson, D.J. Colorectal cancer screening: recommendations for physicians and patients from the U.S. multi-society task force on colorectal cancer. Gastroenterology, 2017, 153(1), 307-323.
[http://dx.doi.org/10.1053/j.gastro.2017.05.013 ] [PMID: 28600072]
[2]
Sulz, M.C. Kroger, A.; Prakash, M.; Manser, C.N.; Heinrich, H.; Misselwitz, B. Meta-analysis of the effect of bowel preparation on adenoma detection: early adenomas affected stronger than advanced adenomas. PLoS One, 2016, 11(6)e0154149
[http://dx.doi.org/10.1371/journal.pone.0154149 ] [PMID: 27257916]
[3]
Hsu, C.M.; Lin, W.P.; Su, M.Y.; Chiu, C.T.; Ho, Y.P.; Chen, P.C. Factors that influence cecal intubation rate during colonoscopy in deeply sedated patients. J. Gastroenterol. Hepatol., 2012, 27(1), 76-80.
[http://dx.doi.org/10.1111/j.1440-1746.2011.06795.x ] [PMID: 21649720]
[4]
Sharara, A.I.; Abou Mrad, R.R. The modern bowel preparation in colonoscopy. Gastroenterol. Clin. North Am., 2013, 42(3), 577-598.
[http://dx.doi.org/10.1016/j.gtc.2013.05.010 ] [PMID: 23931861]
[5]
Johnson, M.R.; Grubber, J.; Grambow, S.C.; Maciejewski, M.L.; Dunn-Thomas, T.; Provenzale, D.; Fisher, D.A. Physician Non-adherence to Colonoscopy Interval Guidelines in the Veterans Affairs Healthcare System. Gastroenterology, 2015, 149(4), 938-951.
[http://dx.doi.org/10.1053/j.gastro.2015.06.026 ] [PMID: 26122143]
[6]
Bugajski, M.; Wieszczy, P.; Hoff, G.; Rupinski, M.; Regula, J.; Kaminski, M.F. Modifiable factors associated with patient-reported pain during and after screening colonoscopy. Gut, 2018, 67(11), 1958-1964.
[http://dx.doi.org/10.1136/gutjnl-2017-313905 ] [PMID: 28970289]
[7]
Yadlapati, R.; Johnston, E.R.; Gregory, D.L.; Ciolino, J.D.; Cooper, A.; Keswani, R.N. Predictors of inadequate inpatient colonoscopy preparation and its association with hospital length of stay and costs. Dig. Dis. Sci., 2015, 60(11), 3482-3490.
[http://dx.doi.org/10.1007/s10620-015-3761-2 ] [PMID: 26093612]
[8]
Gimeno-Garcia A.Z.; Baute, J.L.; Hernandez, G.; Morales, D.; Gonzalez-Perez, C.D.; Nicolas-Perez, D.; Alarcon-Fernandez, O.; Jimenez, A.; Hernandez-Guerra, M.; Romero, R.; Alonso, I.; Gonzalez, Y.; Adrian, Z.; Carrillo, M.; Ramos, L.; Quintero, E. Risk factors for inadequate bowel preparation: a validated predictive score. Endoscopy. USA Georg Thieme Verlag ; , 2017, Vol. 49, pp. 536-543.
[9]
Froehlich, F.; Wietlisbach, V.; Gonvers, J.J.; Burnand, B.; Vader, J.P. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European panel of appropriateness of gastrointestinal endoscopy European multicenter study. Gastrointest. Endosc., 2005, 61(3), 378-384.
[http://dx.doi.org/10.1016/S0016-5107(04)02776-2 ] [PMID: 15758907]
[10]
Galia, A.; Niv, Y. Predictors of inadequate colonic preparation for colonoscopy. Am. J. Gastroenterol., 2002, 97(1), 216.
[http://dx.doi.org/10.1111/j.1572-0241.2002.05416.x ] [PMID: 11808962]
[11]
Chung, Y.W.; Han, D.S.; Park, K.H.; Kim, K.O.; Park, C.H.; Hahn, T.; Yoo, K.S.; Park, S.H.; Kim, J.H.; Park, C.K. Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea. J. Clin. Gastroenterol., 2009, 43(5), 448-452.
[http://dx.doi.org/10.1097/MCG.0b013e3181662442 ] [PMID: 18978506]
[12]
Lebwohl, B.; Wang, T.C.; Neugut, A.I. Socioeconomic and other predictors of colonoscopy preparation quality. Dig. Dis. Sci., 2010, 55(7), 2014-2020.
[http://dx.doi.org/10.1007/s10620-009-1079-7 ] [PMID: 20082217]
[13]
Yi, L.J.; Tian, X.; Pi, Y.P.; Feng, L.; Chen, H.; Liu, X.L.; Chen, W.Q. Comparative efficacy of low volume versus traditional standard volume PEG on bowel preparation before colonoscopy: protocol for an updated meta-analysis with trial sequential analysis. Medicine (Baltimore), 2018, 97(17)e0599
[http://dx.doi.org/10.1097/MD.0000000000010599 ] [PMID: 29703060]
[14]
Davis, G.R.; Santa Ana, C.A.; Morawski, S.G.; Fordtran, J.S. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology, 1980, 78(5 Pt 1), 991-995.
[http://dx.doi.org/10.1016/0016-5085(80)90781-7 ] [PMID: 7380204]
[15]
Golub, R.W.; Kerner, B.A.; Wise, W.E., Jr; Meesig, D.M.; Hartmann, R.F.; Khanduja, K.S.; Aguilar, P.S. Colonoscopic bowel preparations--which one? A blinded, prospective, randomized trial. Dis. Colon Rectum, 1995, 38(6), 594-599.
[http://dx.doi.org/10.1007/BF02054117 ] [PMID: 7774469]
[16]
Siddique, S.; Lopez, K.T.; Hinds, A.M.; Ahmad, D.S.; Nguyen, D.L.; Matteson-Kome, M.L.; Puli, S.R.; Bechtold, M.L. Miralax with gatorade for bowel preparation: a meta-analysis of randomized controlled trials. Am. J. Gastroenterol., 2014, 109(10), 1566-1574.
[http://dx.doi.org/10.1038/ajg.2014.238 ] [PMID: 25135007]
[17]
Adamcewicz, M.; Bearelly, D.; Porat, G.; Friedenberg, F.K. Mechanism of action and toxicities of purgatives used for colonoscopy preparation. Expert Opin. Drug Metab. Toxicol., 2011, 7(1), 89-101.
[http://dx.doi.org/10.1517/17425255.2011.542411 ] [PMID: 21162694]
[18]
Bechtold, M.L.; Mir, F.; Puli, S.R.; Nguyen, D.L. Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization. Ann. Gastroenterol., 2016, 29(2), 137-146.
[http://dx.doi.org/10.20524/aog.2016.0005]
[19]
Padayatty, S.J.; Levine, M. New insights into the physiology and pharmacology of vitamin C. CMAJ, 2001, 164(3), 353-355.
[PMID: 11232136]
[20]
Clark, R.E.; Godfrey, J.D.; Choudhary, A.; Ashraf, I.; Matteson, M.L.; Bechtold, M.L. Low-volume polyethylene glycol and bisacodyl for bowel preparation prior to colonoscopy: a meta-analysis. Ann. Gastroenterol., 2013, 26(4), 319-324.
[http://dx.doi.org/10.14309/00000434-201110002-01377 ] [PMID: 24714413]
[21]
Rees, D.C.; Kelsey, H.; Richards, J.D.M. Acute haemolysis induced by high dose ascorbic acid in glucose-6-phosphate dehydrogenase deficiency. BMJ, 1993, 306(6881), 841-842.
[http://dx.doi.org/10.1136/bmj.306.6881.841 ] [PMID: 8490379]
[22]
Kump, P.; Hassan, C.; Spada, C.; Brownstone, E.; Datz, C.; Haefner, M.; Renner, F.; Schoefl, R.; Schreiber, F. Efficacy and safety of a new low-volume PEG with citrate and simethicone bowel preparation for colonoscopy (Clensia): a multicenter randomized observer-blind clinical trial vs. a low-volume PEG with ascorbic acid (PEG-ASC). Endosc. Int. Open, 2018, 6(8), E907-E913.
[http://dx.doi.org/10.1055/a-0624-2266 ] [PMID: 30083580]
[23]
Ajani, S.; Hurt, R.T.; Teeters, D.A.; Bellmore, L.R. Ischaemic colitis associated with oral contraceptive and bisacodyl use. BMJ Case Rep.,, 2012. 2012bcr1220115451
[http://dx.doi.org/10.1136/bcr-12-2011-5451] [PMID: 22843752]
[24]
Vanner, S.J.; MacDonald, P.H.; Paterson, W.G.; Prentice, R.S.A.; Da Costa, L.R.; Beck, I.T. A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy. Am. J. Gastroenterol., 1990, 85(4), 422-427.
[PMID: 2183591]
[25]
Tan, J.J.Y.; Tjandra, J.J. Which Is the Optimal Bowel Preparation for Colonoscopy-a Meta-Analysis. Colorectal Dis., 2006, 8(4), 247-258.
[http://dx.doi.org/10.1111/j.1463-1318.2006.00970.x.]
[26]
Frizelle, F.A.; Colls, B.M. Hyponatremia and seizures after bowel preparation: report of three cases. Dis. Colon Rectum, 2005, 48(2), 393-396.
[http://dx.doi.org/10.1007/s10350-004-0778-6 ] [PMID: 15812590]
[27]
Clarkston, W.K.; Tsen, T.N.; Dies, D.F.; Schratz, C.L.; Vaswani, S.K.; Bjerregaard, P. Oral sodium phosphate versus sulfate-free polyethylene glycol electrolyte lavage solution in outpatient preparation for colonoscopy: a prospective comparison. Gastrointest. Endosc., 1996, 43(1), 42-48.
[http://dx.doi.org/10.1016/S0016-5107(96)70259-6 ] [PMID: 8903817]
[28]
Beloosesky, Y.; Grinblat, J.; Weiss, A.; Grosman, B.; Gafter, U.; Chagnac, A. Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients. Arch. Intern. Med., 2003, 163(7), 803-808.
[http://dx.doi.org/10.1001/archinte.163.7.803 ] [PMID: 12695271]
[29]
Markowitz, G.S.; Stokes, M.B.; Radhakrishnan, J.; D’Agati, V.D. Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an underrecognized cause of chronic renal failure. J. Am. Soc. Nephrol., 2005, 16(11), 3389-3396.
[http://dx.doi.org/10.1681/ASN.2005050496 ] [PMID: 16192415]
[30]
Palmadottir V.K.; Gudmundsson, H.; Hardarson, S.; Arnadottir, M.; Magnusson, T.; Andresdottir, M.B. Incidence and outcome of acute phosphate nephropathy in Iceland. PLoS One, 2010, 5(10)e13484
[http://dx.doi.org/10.1371/journal.pone.0013484 ] [PMID: 20976065]
[31]
Zwas, F.R.; Cirillo, N.W.; el-Serag, H.B.; Eisen, R.N. Colonic mucosal abnormalities associated with oral sodium phosphate solution. Gastrointest. Endosc., 1996, 43(5), 463-466.
[http://dx.doi.org/10.1016/S0016-5107(96)70286-9 ] [PMID: 8726758]
[32]
Hamilton, D.; Mulcahy, D.; Walsh, D.; Farrelly, C.; Tormey, W.P.; Watson, G. Sodium picosulphate compared with polyethylene glycol solution for large bowel lavage: a prospective randomised trial. Br. J. Clin. Pract., 1996, 50(2), 73-75.
[PMID: 8731641]
[33]
Katz, P.O.; Rex, D.K.; Epstein, M.; Grandhi, N.K.; Vanner, S.; Hookey, L.C.; Alderfer, V.; Joseph, R.E.A. A dual-action, low-volume bowel cleanser administered the day before colonoscopy: results from the SEE CLEAR II study. Am. J. Gastroenterol., 2013, 108(3), 401-409.
[http://dx.doi.org/10.1038/ajg.2012.441 ] [PMID: 23318484]
[34]
Weir, M.A.; Fleet, J.L.; Vinden, C.; Shariff, S.Z.; Liu, K.; Song, H.; Jain, A.K.; Gandhi, S.; Clark, W.F.; Garg, A.X. Hyponatremia and sodium picosulfate bowel preparations in older adults. Am. J. Gastroenterol., 2014, 109(5), 686-694.
[http://dx.doi.org/10.1038/ajg.2014.20 ] [PMID: 24589671]
[35]
Di Palma, J.A.; Rodriguez, R.; McGowan, J.; Cleveland, Mv. A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy. Am. J. Gastroenterol., 2009, 104(9), 2275-2284.
[http://dx.doi.org/10.1038/ajg.2009.389 ] [PMID: 19584830]
[36]
Schelling, J.R. Fatal hypermagnesemia. Clin. Nephrol., 2000, 53(1), 61-65.
[PMID: 10661484]
[37]
Kontani, M.; Hara, A.; Ohta, S.; Ikeda, T. Hypermagnesemia induced by massive cathartic ingestion in an elderly woman without pre-existing renal dysfunction. Intern. Med., 2005, 44(5), 448-452.
[http://dx.doi.org/10.2169/internalmedicine.44.448 ] [PMID: 15942092]
[38]
Gweon, T.G.; Kim, S.W.; Noh, Y.S.; Hwang, S.; Kim, N.Y.; Lee, Y.; Lee, S.W.; Lee, S.W.; Lee, J.Y.; Lim, C.H.; Hun Kim, H.; Kim, J.S.; Kyung Cho, Y.; Myung Park, J.; Seok Lee, I. Myung-Gyu Choi, Prospective, randomized comparison of same-day dose of 2 different bowel cleanser for afternoon colonoscopy: picosulfate, magnesium oxide, and citric acid versus polyethylene glycol. Medicine (Baltimore), 2015, 94(13)e628
[http://dx.doi.org/10.1097/MD.0000000000000628 ] [PMID: 25837751]
[39]
Pohl, J.; Halphen, M.; Kloess, H.R.; Fischbach, W. Impact of the quality of bowel cleansing on the efficacy of colonic cancer screening: a prospective, randomized, blinded study. PLoS One, 2015, 10(5)e0126067
[http://dx.doi.org/10.1371/journal.pone.0126067 ] [PMID: 25950434]
[40]
Worthington, J.; Thyssen, M.; Chapman, G.; Chapman, R.; Geraint, M. A randomised controlled trial of a new 2 litre polyethylene glycol solution versus sodium picosulphate + magnesium citrate solution for bowel cleansing prior to colonoscopy. Curr. Med. Res. Opin., 2008, 24(2), 481-488.
[http://dx.doi.org/10.1185/030079908X260844 ] [PMID: 18179734]
[41]
FDA approves low-volume colonoscopy prep Plenvu. Available from: https://www.healio.com/news/gastroenterology/20180507/fda-approves-lowvolume-colonoscopy-prep-plenvu#:~:text=The%20FDA%20has%20approved%20Plenvu,focus%20on%20the%20ascending%20colon
[42]
Plenvu Powder for oral solution composite pack - NPS MedicineWise. Available from: mydr.com.au/medicines/plenvu-powder-for-oral-solution-composite-pack
[43]
Halphen, M.; Heresbach, D.; Gruss, H-J.; Belsey, J. Validation of the Harefield Cleansing Scale: a tool for the evaluation of bowel cleansing quality in both research and clinical practice. Gastrointest. Endosc., 2013, 78(1), 121-131.
[http://dx.doi.org/10.1016/j.gie.2013.02.009 ] [PMID: 23531426]
[44]
Schreiber, S.; Baumgart, D.C.; Drenth, J.P.H.; Filip, R.S.; Clayton, L.B.; Hylands, K.; Repici, A.; Hassan, C. DAYB Study Group Colon cleansing efficacy and safety with 1 L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial. Endoscopy, 2019, 51(1), 73-84.
[http://dx.doi.org/10.1055/a-0639-5070 ] [PMID: 30025415]
[45]
Bisschops, R.; Manning, J.; Clayton, L.B.; Ng Kwet Shing, R. Alvarez-Gonzalez, M. MORA Study Group. Colon cleansing efficacy and safety with 1 L NER1006 versus 2 L polyethylene glycol + ascorbate: a randomized phase 3 trial. Endoscopy, 2019, 51(1), 60-72.
[http://dx.doi.org/10.1055/a-0638-8125 ] [PMID: 30025414]
[46]
Lai, E.J.; Calderwood, A.H.; Doros, G.; Fix, O.K.; Jacobson, B.C. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest. Endosc., 2009, 69(3 Pt 2), 620-625.
[http://dx.doi.org/10.1016/j.gie.2008.05.057 ] [PMID: 19136102]
[47]
DeMicco, M.P.; Clayton, L.B.; Pilot, J.; Epstein, M.S. NOCT Study Group Novel 1 L polyethylene glycol-based bowel preparation NER1006 for overall and right-sided colon cleansing: a randomized controlled phase 3 trial versus trisulfate. Gastrointest. Endosc., 2018, 87(3), 677-687.e3.
[http://dx.doi.org/10.1016/j.gie.2017.07.047 ] [PMID: 28803744]
[48]
Rex, D.K. Hyperosmotic low-volume bowel preparations: Is NER1006 safe? Gastrointest. Endosc., 2019, 89(3), 656-658.
[http://dx.doi.org/10.1016/j.gie.2018.11.009 ] [PMID: 30448411]
[49]
Maida, M. Safety of NER1006. Gastrointest. Endosc., 2019, 90(3), 540-541.
[http://dx.doi.org/10.1016/j.gie.2019.04.213 ] [PMID: 31439143]
[50]
Rex, D.K.; Levy, C.L.; Bensen, S.; Toor, A.; Parker, S.; Knuth, D.; Allio, M; Stern, H.B.; Siegel, C.A. Edible colon preparation shows excellent efficacy, safety and tolerability in a phase 2, randomized trial. Am. J. Gastroentero 2016. 111, S105.

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