Comparison between pulsed irrigation enhanced evacuation and polyethylene glycol-electrolyte lavage solution for bowel preparation prior to elective colonoscopy in veterans with spinal cord injury

The Journal of Spinal Cord Medicine, 2015 · DOI: 10.1179/2045772314Y.0000000256 · Published: January 1, 2015

Simple Explanation

This study compares two methods of bowel preparation for colonoscopy in individuals with spinal cord injury (SCI): pulsed irrigation enhanced evacuation (PIEE) and polyethylene glycol-electrolyte lavage solution (PEG). People with SCI often have difficulty with bowel preparation due to evacuation problems and decreased colonic motility. The goal was to determine which method provides a more effective bowel cleansing before colonoscopy. Poor bowel preparation can lead to missed polyps and an increased risk of colorectal cancer (CRC) in this population. Neither PIEE nor PEG produced acceptable bowel preparation for colonoscopy in subjects with SCI in this study. Alternative bowel cleansing approaches should be considered in future studies.

Study Duration

3 years 5 months

Participants

24 subjects with SCI

Evidence Level

Not specified

Key Findings

1
Patients with SCI who received PIEE tended to have lower Ottawa scores and a higher percentage of acceptable preparations than did those who received PEG; however, the results were not statistically different.
2
In this preliminary study in subjects with SCI, neither PIEE nor PEG produced acceptable bowel preparation for elective colonoscopy.
3
A number of subjects in the PIEE bowel preparation group reported significant gastrointestinal (GI) discomfort from the preparation prescribed and/or indicated that they would not likely consider that particular approach to be used for bowel cleansing in preparation for a future colonoscopy

Research Summary

This study evaluated the effectiveness of pulsed irrigation enhanced evacuation (PIEE) versus polyethylene glycol-electrolyte lavage solution (PEG) for bowel preparation prior to colonoscopy in individuals with spinal cord injury (SCI). The results indicated that neither PIEE nor PEG resulted in acceptable bowel preparation, as defined by an Ottawa score (OS) of ≤3, in this population. The authors suggest future research should explore alternative bowel cleansing methods for individuals with SCI to improve polyp detection rates and reduce the risk of colorectal cancer.

Practical Implications

Need for Alternative Bowel Prep Methods

Current standard bowel preparation methods (PIEE and PEG) may not be sufficient for individuals with SCI. Further research is needed to identify more effective methods.

Improved Polyp Detection

More efficacious bowel cleansing approaches could improve the rate of polyp detection and excision during colonoscopy in individuals with SCI.

Reduced Colorectal Cancer Risk

Improved bowel preparation leading to better polyp detection and excision may reduce the occurrence of colonic malignancy and improve overall health and survival in the SCI population.

Study Limitations

1
Small sample size (n=24)
2
The study did not define subjects based on colonic phenotype (flaccid bowel vs. spastic bowel function)
3
Ottawa scores were not significantly different between the groups

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury