Faktors determining effective and reliable colonoscopy preparation

Purpose:It is very important to have adequate bowel preparation before colonoscopy for the diagnosis and treatment of colorectal diseases. Being completely clean during the procedure increases the success of the examination and prevents the procedure from being repeated. Today, there are standard practices with proven effectiveness for adequate colon cleansing.Despite standard practices, adequate colon cleansing cannot be achieved in some patients. In this study, we aimed to evaluate the importance of colonoscopy preparation and to determine the factors that have a positive or negative effect on colonoscopy preparation. We think that with the results to be obtained in this study, we can determine the optimal colonoscopy preparation method suitable for each patient, and thus, we can reduce the number of unnecessary procedures with optimal preparation, increase the chance of success in the procedure, and as a result, we can achieve beneficial results in terms of patients and costs. Method:This study was carried out in Aydın Adnan Menderes University Practice and Research Hospital, Department of Internal Medicine, Gastroenterology Clinic, Endoscopy Unit, between January 2021 and January 2022. It is a descriptive and analytical-cross-sectional type of research. All patients who underwent colonoscopy between January 2021 and January 2022 in Aydın Adnan Menderes University Application and Research Hospital Gastroenterology Clinic Endoscopy Unit were included in the study. As data collection tools, a questionnaire prepared by the researcher, developed in line with the relevant literature, and the Boston colonoscopy preparation evaluation scale (routinely applied to patients who are prepared for colonoscopy) will be used. Results:A total of 303 patients, 155 women and 148 men, were included in the study. It was determined that 70.3% of the patients used drugs continuously, 70.3% had a comorbid disease, and 10.2% had a family history of colon ca. It was determined that Laxeno/Sennozid A+B Calcium containing preparations were used most frequently (55.4%) for bowel cleansing. When the drug-related side effects were evaluated, it was observed that the most common (45.6%) patients experienced nausea and vomiting.Side effects were found at a rate of 64.6% for those who used lax phosphosoda/sodium phosphate for intestinal cleansing, 54.8% for those who used laxeno/sennoside A+B calcium, and 54.3% for those who used pegdin/polyethyleneglycol. However, no statistical significance was found between the groups. Nausea and vomiting were the most common side effects for all three drugs. When the Boston bowel preparation scale applied to the patients was evaluated, it was seen that the patients most frequently scored 2 and 3 from all colon segments.When the biochemistry parameters before and after the procedure were evaluated, a statistically significant difference was found in terms of creatinine, Na, K, P, Ca parameters. When the biochemistry parameters before and after the colonoscopy procedure are evaluated according to the drugs used for bowel cleansing, the P parameter between before and after the procedure in those using lax phosphosoda/sodium phosphate, creatinine and P parameters between before and after the procedure in those using the laxeno/sennoside A+B calcium drug. A statistically significant difference was found between the pre- and post-procedure users in terms of Ca parameter in those using the polyethyleneglycol drug. Conclusion:In conclusion, in this study, we found that age and gender had no effect on the quality of bowel cleansing. We found that there was no correlation between the increase in educational status and the quality of bowel cleansing. When the effects of the presence of comorbidity in the patients were examined, we found that it had no effect on the quality of the preparation. However, in our study, no additional evaluation was made about specific comorbidities and whether these comorbid conditions were under control. When the difference in cleaning quality and the presence of side effects between the agents used were evaluated, no superiority was found to each other.When the renal damage and electrolyte imbalance that may develop due to the agents used were evaluated, it was found that there was no effect after PEG use, increased phosphate after NaP and senna use, and increased creatinine after senna use. However, the duration of this imbalance, which developed after the use of NaP and senna, and the permanent damage status were not evaluated. And no dose adjustment was made according to the patient group characteristics of the agents. We are of the opinion that more clear data can be obtained on this subject with studies to be conducted with longer follow-up and different dose adjustments. Keywords:Renal Injury, Intestinal Cleansing Quality, Boston Bowel Preparation Scale