Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2023; 29(46): 6022-6027
Published online Dec 14, 2023. doi: 10.3748/wjg.v29.i46.6022
Emerging space for non-polyethene-glycol bowel preparations in inflammatory bowel disease-related colonoscopy: Veering toward better adherence and palatability
Raffaele Pellegrino, Antonietta Gerarda Gravina
Raffaele Pellegrino, Antonietta Gerarda Gravina, Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
Author contributions: Pellegrino R and Gravina AG collected the literature, wrote the initial manuscript, conceptualized the table and figure, contributed equally to this work, conceptualized the structure of the text, critically revised the manuscript for important intellectual content, and read and approved the final version of the manuscript.
Conflict-of-interest statement: Raffaele Pellegrino and Antonietta Gerarda Gravina have nothing to disclose.
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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raffaele Pellegrino, MD, Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Via L. de Crecchio, Naples 80138, Italy. raffaele.pellegrino@unicampania.it
Received: October 11, 2023
Peer-review started: October 11, 2023
First decision: November 6, 2023
Revised: November 6, 2023
Accepted: December 1, 2023
Article in press: December 1, 2023
Published online: December 14, 2023

Patients with inflammatory bowel diseases (IBDs) require repeated endoscopic evaluations over time by colonoscopy to weigh disease activity but also for different and additional indications (e.g., evaluation of postoperative recurrence, colorectal cancer surveillance). Colonoscopy, however, requires adequate bowel preparation to be of quality. The latter is achieved as long as the patient takes a certain amount of product to have a number of bowel movements suitable to clean the colon and allow optimal visualization of the mucosa during endoscopy. However, significant guidelines recommend preparations for patients with IBD not excelling in palatability. This recommendation originates from the fact that most of the studies conducted on bowel preparations in patients with IBD have been done with isosmolar preparations based on polyethylene glycol (PEG), for which, therefore, more safety data exist. As a result, the low-volume non-PEG preparations (e.g., magnesium citrate plus picosulphate, oral sulphate solutions) have been set aside for the whole range of warnings to be heeded because of their hyperosmolarity. New studies, however, are emerging, leaning in overall for a paradigm shift in this matter. Indeed, such non-PEG preparations seem to show a particularly encouraging and engaging safety profile when considering their broad potential for tolerability and patient preference. Indeed, such evidence is insufficient to indicate such preparations in all patients with IBD but may pave the way for those with remission or well-controlled disease. This article summarizes the central studies conducted in IBD settings using non-PEG preparations by discussing their results.

Keywords: Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Bowel preparation, Colonoscopy, Polyethylene glycol, Low-volume

Core Tip: Preparations based on polyethylene glycol (PEG) are most recommended for patients with inflammatory bowel disease (IBD) undergoing colonoscopy. However, these solutions are not always palatable because they often require the intake of large volumes of solution, making it difficult for the patient to complete the entire preparation. This leads to a reduction in the quality of the endoscopic examination. Low-volume non-PEG-based, although excluded in the major guidelines for patients with IBD, are emerging as potentially safe in this setting, especially in remission or mild disease conditions.