Di Leo M, Iannone A, Arena M, Losurdo G, Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A. Novel frontiers of agents for bowel cleansing for colonoscopy. World J Gastroenterol 2021; 27(45): 7748-7770 [PMID: 34963739 DOI: 10.3748/wjg.v27.i45.7748]
Corresponding Author of This Article
Alfredo Di Leo, MD, PhD, Doctor, Full Professor, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari 70124, Italy. alfredo.dileo@uniba.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Frontier
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 7, 2021; 27(45): 7748-7770 Published online Dec 7, 2021. doi: 10.3748/wjg.v27.i45.7748
Novel frontiers of agents for bowel cleansing for colonoscopy
Milena Di Leo, Andrea Iannone, Monica Arena, Giuseppe Losurdo, Maria Angela Palamara, Giuseppe Iabichino, Pierluigi Consolo, Maria Rendina, Carmelo Luigiano, Alfredo Di Leo
Milena Di Leo, Monica Arena, Maria Angela Palamara, Giuseppe Iabichino, Carmelo Luigiano, Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
Andrea Iannone, Giuseppe Losurdo, Maria Rendina, Alfredo Di Leo, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
Pierluigi Consolo, Unit of Digestive Endoscopy, University of Messina, Hospital "G. Martino", Messina 98121, Italy
Author contributions: Di Leo M and Di Leo A planned the study; Di Leo M, Iannone A, Arena M, Losurdo G wrote the manuscript; Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A supervised the study; all authors read and approved the final version.
Conflict-of-interest statement: No conflict-of-interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alfredo Di Leo, MD, PhD, Doctor, Full Professor, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari 70124, Italy. alfredo.dileo@uniba.it
Received: March 17, 2021 Peer-review started: March 17, 2021 First decision: April 15, 2021 Revised: April 23, 2021 Accepted: November 24, 2021 Article in press: November 24, 2021 Published online: December 7, 2021
Abstract
The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’ acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’ tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.
Core Tip: Colonoscopy is the best modality for colorectal cancer (CRC) screening, preventing death from CRC through removal of adenomatous polyps and early detection of CRC. The accuracy of colonoscopy is related to quality of bowel preparation (BP). International guidelines underlined the methods to improve BP. In this review, we aimed to summarize the current strategy to increase bowel cleansing before colonoscopy.
