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Kolonoskopi öncesi bağırsak hazırlığında sennosid A + B kalsiyum solüsyonları ile polietilen glikol solüsyonlarının etkinliğinin retrospektif karşılaştırması

Yıl 2025, Cilt: 24 Sayı: 2, 93 - 102, 20.08.2025
https://doi.org/10.17941/agd.1763577

Öz

Giriş ve Amaç: Kolonoskopi, kolorektal hastalıkların tanısında yaygın olarak kullanılan bir yöntemdir. Bu yöntemin tanısal doğruluğu büyük ölçüde bağırsak hazırlığının kalitesine bağlıdır. Yaygın olarak kullanılan iki bağırsak temizleme ajanı sennosid A + B kalsiyum ve polietilen glikol solüsyonlarıdır. Bu çalışma, farklı bağırsak hazırlık skorlama sistemleri kullanılarak bu iki ajanın etkinliğini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntem: Şubat 2024 ile Nisan 2025 tarihleri arasında üçüncü basamak bir merkezde, tek bir endoskopist tarafından gerçekleştirilen kolonoskopiler retrospektif olarak değerlendirildi. Hastalar, bilgilendirilmiş tercihleri doğrultusunda polietilen glikol veya sennosid A + B kalsiyum solüsyonu ile bağırsak hazırlığı aldı. Bağırsak temizliği kalitesi, Boston bağırsak hazırlık skalası, Ottawa bağırsak hazırlık skalası ve Chicago bağırsak hazırlık skalası kullanılarak segmental olarak değerlendirildi. Bulgular: Toplam 114 hasta çalışmaya dahil edildi. Polietilen glikol grubunda (n = 53), Boston bağırsak hazırlık skalası ve Chicago bağırsak hazırlık skalası skorları anlamlı derecede daha yüksek; Ottawa bağırsak hazırlık skalası skorları ise daha düşük (daha iyi) bulundu. Bu, polietilen glikolün sennosid grubuna (n = 61) kıyasla üstün bağırsak temizliği sağladığını göstermektedir. Boston ve Ottawa bağırsak hazırlık skalaları arasında güçlü negatif korelasyon, Boston ve Chicago bağırsak hazırlık skalaları arasında ise güçlü pozitif korelasyon saptandı. Ottawa ve Chicago bağırsak hazırlık skalaları arasında da güçlü negatif korelasyon gözlendi. Önceki kolonoskopi sayısı ve son kolonoskopiden geçen süre ile üç bağırsak hazırlık skalası arasında istatistiksel olarak anlamlı bir ilişki bulunmadı. Sonuç: Bu çalışma, üç farklı ve birbiriyle güçlü korelasyon gösteren skorlama sistemi kullanılarak değerlendirildiğinde, polietilen glikol solüsyonlarının sennosid A + B kalsiyuma göre anlamlı şekilde daha iyi bağırsak temizliği sağladığını göstermiştir. Bulgular, daha düşük beden kitle indeksinin ve önceki kolonoskopi deneyiminin daha iyi bağırsak hazırlığı ile ilişkili olabileceğini, bunun da muhtemelen hasta uyumunun daha yüksek olmasından kaynaklandığını düşündürmektedir. Her iki ajan da klinik uygulamada yaygın olarak kullanılsa da, özellikle daha önce kolonoskopi yaptırmış ve yeterli bağırsak temziliği elde edilememiş hastalarda polietilen glikol solüsyonları tercih edilebilir.

Kaynakça

  • 1. Løberg M, Kalager M, Holme Ø, et al. Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med. 2014;371(9):799-807.
  • 2. Baxter NN, Goldwasser MA, Paszat LF, et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150(1):1-8.
  • 3. Sulz MC, Kröger A, Prakash M, et al. Meta-Analysis of the Effect of Bowel Preparation on Adenoma Detection: Early Adenomas Affected Stronger than Advanced Adenomas. PLoS One. 2016;11(6):e0154149.
  • 4. Johnson DA, Barkun AN, Cohen LB, et al; US Multi-Society Task Force on Colorectal Cancer. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology. 2014;147(4):903-24.
  • 5. Lee TJW, Rutter MD, Blanks RG, et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut. 2012;61(7):1050-7.
  • 6. Radaelli F, Meucci G, Sgroi G, Minoli G; Italian Association of Hospital Gastroenterologists (AIGO). Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators. Am J Gastroenterol. 2008;103(5):1122-30.
  • 7. Maida M, Annibale B, Benedetti A, et al; Italian Society of Gastroenterology (SIGE). Quality of endoscopic screening for colorectal cancer in Italy: A national survey. Dig liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2022;54(10):1410-8.
  • 8. Rex DK, Imperiale TF, Latinovich DR, Bratcher LL. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002;97(7):1696-700.
  • 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):378-84.
  • 10. Wexner SD, Beck DE, Baron TH, et al; American Society of Colon and Rectal Surgeons; American Society for Gastrointestinal Endoscopy; Society of American Gastrointestinal and Endoscopic Surgeons. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc. 2006;63(7):894-909.
  • 11. Hillyer GC, Basch CH, Lebwohl B, et al. Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: results of a national survey. Int J Colorectal Dis. 2013;28(1):73-81.
  • 12. Altinbaş A, Yilmaz B, Aktaş B, et al. What is the main target: a clearer colon with a sennoside-based regime, or adequate bowel cleansing before colonoscopy with a PEG-EL-based regime? Turkish J Med Sci. 2015;45(2):404-8.
  • 13. Manukyan MN, Tolan K, Severge U, et al. Prospective randomized comparison of oral sodium phosphate and sennoside A+B calcium lavage for colonoscopy preparation. Surg Laparosc Endosc Percutan Tech. 2011;21(2):90-3.
  • 14. Schanz S, Kruis W, Mickisch O, et al. Bowel Preparation for Colonoscopy with Sodium Phosphate Solution versus Polyethylene Glycol-Based Lavage: A Multicenter Trial. Diagn Ther Endosc. 2008;2008:713521.
  • 15. Kastenberg D, Bertiger G, Brogadir S. Bowel preparation quality scales for colonoscopy. World J Gastroenterol. 2018;24(26):2833-43.
  • 16. Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology. 1980;78(5 Pt 1):991-5.
  • 17. Wexner SD, Beck DE, Baron TH, et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestina. Dis Colon Rectum. 2006;49(6):792-809.
  • 18. Coskun Y, Yuksel I. Polyethylene glycol versus split high-dose senna for bowel preparation: A comparative prospective randomized study. J Gastroenterol Hepatol. 2020;35(11):1923-9.
  • 19. Børkje B, Pedersen R, Lund GM, Enehaug JS, Berstad A. Effectiveness and acceptability of three bowel cleansing regimens. Scand J Gastroenterol. 1991;26(2):162-6.
  • 20. Hangartner PJ, Münch R, Meier J, Ammann R, Bühler H. Comparison of three colon cleansing methods: evaluation of a randomized clinical trial with 300 ambulatory patients. Endoscopy. 1989;21(6):272-5.
  • 21. Shavakhi A, Kianinia M, Torabi G, et al. High dose Senna or Poly Ethylene Glycol (PEG) for elective colonoscopy preparation: a prospective randomized investigator-blinded clinical trial. J Res Med Sci. 2011;16(2):149-55.
  • 22. Tasci I, Altinli E, Sirin F. Bowel cleansing for diagnostic colonoscopy: which method is preferable? Istanbul experience. Tech Coloproctol. 2003;7(1):18-21.
  • 23. Radaelli F, Meucci G, Imperiali G, et al. High-dose senna compared with conventional PEG-ES lavage as bowel preparation for elective colonoscopy: a prospective, randomized, investigator-blinded trial. Am J Gastroenterol. 2005;100(12):2674-80.
  • 24. Li C-X, Guo Y, Zhu Y-J, et al. Comparison of Polyethylene Glycol versus Lactulose Oral Solution for Bowel Preparation prior to Colonoscopy. Gastroenterol Res Pract. 2019;2019:2651450.

A retrospective comparison of the efficacy of sennoside A + B calcium solutions and polyethylene glycol solutions for bowel preparation prior colonoscopy

Yıl 2025, Cilt: 24 Sayı: 2, 93 - 102, 20.08.2025
https://doi.org/10.17941/agd.1763577

Öz

Background and Aim: Colonoscopy is a widely used method for diagnosing colorectal diseases. Its diagnostic accuracy largely depends on the quality of bowel preparation. Two commonly used bowel cleansing agents are sennoside A + B calcium and polyethylene glycol solutions. This study aims to compare the effectiveness of these two agents using different bowel preparation scoring systems. Materials and Method: Colonoscopies performed by a single endoscopist at a tertiary center between February 2024 and April 2025 were retrospectively evaluated. Patients received either polyethylene glycol or sennoside A + B calcium solutions for bowel preparation, based on informed patient preference. Bowel cleansing quality was assessed segmentally using the Boston bowel preparation scale, the Ottawa bowel preparation scale, and the Chicago bowel preparation scale. Results: A total of 114 patients were included in the study. The polyethylene glycol group (n = 53) achieved significantly higher scores on the Boston bowel preparation scale and the Chicago bowel preparation scale, and lower (better) scores on the Ottawa bowel preparation scale, indicating superior bowel cleansing quality compared to the sennoside group (n = 61). A strong negative correlation was observed between the Boston and Ottawa bowel preparation scales, while a strong positive correlation was found between the Boston and Chicago bowel preparation scales. The Ottawa and Chicago bowel preparation scales also demonstrated a strong negative correlation. No statistically significant correlations were found between the number of previous colonoscopies or the time since the last procedure and any of the three bowel preparation scales. Conclusion: This study demonstrated that polyethylene glycol solutions provide significantly better bowel cleansing quality compared to sennoside A + B calcium, as evaluated using three strongly correlated bowel preparation scales. The findings suggest that lower body mass index and previous colonoscopy experience may be associated with improved bowel preparation, possibly due to better patient adherence. While both agents are commonly used in clinical practice, polyethylene glycol solutions may be the preferred option, especially in patients who have undergone prior colonoscopy with inadequate bowel cleansing.

Kaynakça

  • 1. Løberg M, Kalager M, Holme Ø, et al. Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med. 2014;371(9):799-807.
  • 2. Baxter NN, Goldwasser MA, Paszat LF, et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150(1):1-8.
  • 3. Sulz MC, Kröger A, Prakash M, et al. Meta-Analysis of the Effect of Bowel Preparation on Adenoma Detection: Early Adenomas Affected Stronger than Advanced Adenomas. PLoS One. 2016;11(6):e0154149.
  • 4. Johnson DA, Barkun AN, Cohen LB, et al; US Multi-Society Task Force on Colorectal Cancer. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology. 2014;147(4):903-24.
  • 5. Lee TJW, Rutter MD, Blanks RG, et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut. 2012;61(7):1050-7.
  • 6. Radaelli F, Meucci G, Sgroi G, Minoli G; Italian Association of Hospital Gastroenterologists (AIGO). Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators. Am J Gastroenterol. 2008;103(5):1122-30.
  • 7. Maida M, Annibale B, Benedetti A, et al; Italian Society of Gastroenterology (SIGE). Quality of endoscopic screening for colorectal cancer in Italy: A national survey. Dig liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2022;54(10):1410-8.
  • 8. Rex DK, Imperiale TF, Latinovich DR, Bratcher LL. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002;97(7):1696-700.
  • 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):378-84.
  • 10. Wexner SD, Beck DE, Baron TH, et al; American Society of Colon and Rectal Surgeons; American Society for Gastrointestinal Endoscopy; Society of American Gastrointestinal and Endoscopic Surgeons. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc. 2006;63(7):894-909.
  • 11. Hillyer GC, Basch CH, Lebwohl B, et al. Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: results of a national survey. Int J Colorectal Dis. 2013;28(1):73-81.
  • 12. Altinbaş A, Yilmaz B, Aktaş B, et al. What is the main target: a clearer colon with a sennoside-based regime, or adequate bowel cleansing before colonoscopy with a PEG-EL-based regime? Turkish J Med Sci. 2015;45(2):404-8.
  • 13. Manukyan MN, Tolan K, Severge U, et al. Prospective randomized comparison of oral sodium phosphate and sennoside A+B calcium lavage for colonoscopy preparation. Surg Laparosc Endosc Percutan Tech. 2011;21(2):90-3.
  • 14. Schanz S, Kruis W, Mickisch O, et al. Bowel Preparation for Colonoscopy with Sodium Phosphate Solution versus Polyethylene Glycol-Based Lavage: A Multicenter Trial. Diagn Ther Endosc. 2008;2008:713521.
  • 15. Kastenberg D, Bertiger G, Brogadir S. Bowel preparation quality scales for colonoscopy. World J Gastroenterol. 2018;24(26):2833-43.
  • 16. Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology. 1980;78(5 Pt 1):991-5.
  • 17. Wexner SD, Beck DE, Baron TH, et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestina. Dis Colon Rectum. 2006;49(6):792-809.
  • 18. Coskun Y, Yuksel I. Polyethylene glycol versus split high-dose senna for bowel preparation: A comparative prospective randomized study. J Gastroenterol Hepatol. 2020;35(11):1923-9.
  • 19. Børkje B, Pedersen R, Lund GM, Enehaug JS, Berstad A. Effectiveness and acceptability of three bowel cleansing regimens. Scand J Gastroenterol. 1991;26(2):162-6.
  • 20. Hangartner PJ, Münch R, Meier J, Ammann R, Bühler H. Comparison of three colon cleansing methods: evaluation of a randomized clinical trial with 300 ambulatory patients. Endoscopy. 1989;21(6):272-5.
  • 21. Shavakhi A, Kianinia M, Torabi G, et al. High dose Senna or Poly Ethylene Glycol (PEG) for elective colonoscopy preparation: a prospective randomized investigator-blinded clinical trial. J Res Med Sci. 2011;16(2):149-55.
  • 22. Tasci I, Altinli E, Sirin F. Bowel cleansing for diagnostic colonoscopy: which method is preferable? Istanbul experience. Tech Coloproctol. 2003;7(1):18-21.
  • 23. Radaelli F, Meucci G, Imperiali G, et al. High-dose senna compared with conventional PEG-ES lavage as bowel preparation for elective colonoscopy: a prospective, randomized, investigator-blinded trial. Am J Gastroenterol. 2005;100(12):2674-80.
  • 24. Li C-X, Guo Y, Zhu Y-J, et al. Comparison of Polyethylene Glycol versus Lactulose Oral Solution for Bowel Preparation prior to Colonoscopy. Gastroenterol Res Pract. 2019;2019:2651450.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Gastroenteroloji ve Hepatoloji
Bölüm Makaleler
Yazarlar

Ali Atay 0000-0001-6488-8289

Yayımlanma Tarihi 20 Ağustos 2025
Gönderilme Tarihi 29 Mayıs 2025
Kabul Tarihi 16 Haziran 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 24 Sayı: 2

Kaynak Göster

APA Atay, A. (2025). A retrospective comparison of the efficacy of sennoside A + B calcium solutions and polyethylene glycol solutions for bowel preparation prior colonoscopy. Akademik Gastroenteroloji Dergisi, 24(2), 93-102. https://doi.org/10.17941/agd.1763577

test-5