Bowel Preparation Pre-Colonoscopy
Discussion
Studies that investigate the effect of bowel preparation before colonoscopy for people with and without SCI showed mixed results. Ancha et al. (2009) found that 75% of people with SCI had suboptimal preparation prior to elective colonoscopy whereas Song et al. (2018) found 89% of people with SCI had adequate quality of bowel preparation. Ancha et al. (2009) investigated preparation methods for people with SCI using polyethylene glycol (PEG), oral sodium phosphosoda (OSPS), or a combination of both. Between these groups, the quality of bowel preparation based on Ottawa scores did not significantly differ. The authors suggested the use of a prokinetic agent to induce gut motility prior to surgery (Ancha et al. 2009). Further study demonstrated how the injection of neostigmine added to standard bowel preparation routines (MoviPrep low volume polyethylene glycol-electrolyte lavage with ascorbic acid) had some beneficial results for surgical preparation (Korsten et al. 2015). Between the SCI groups (those who received Moviprep and those who received MoviPrep + neostigmine/glycopyrrolate), people who received the prokinetic combination had a greater percentage of acceptable preparation (p=0.05). Although, the numbers recruited did not reach the authors power calculations and they also noted that neostigmine needs to be administered in a monitored, controlled setting.
Lyons et al. (2015) compared 24 people with chronic SCI, 12 in each group, one who received standard split dose of magnesium citrate for 2 days before the procedure and Pulsed Irrigation Enhanced Evacuation (PIEE) the day of the procedure and the other received the oral lavage solution with polyethylene glycol split-dose over 2 days. There was no statistical difference in the quality of bowel preparation although the groups may have been too small to detect a difference. Regardless, PIEE requires specialized equipment and training and is not currently available in most centres. No serious adverse events were reported in this study.
Conclusion
There is level 1 evidence from one RCT (Korsten et al. 2015) that adding neostigimine/glyocpyrrolate to Moviprep before elective colonoscopy for people with SCI improves the quality of preparation in comparison to Moviprep alone. However, the addition of injection of neostigmine to standard bowel preparation needs to be administered in a controlled setting due to potential side effects.
There is level 1 evidence from one randomized controlled trial (Ancha et al. 2009) that oral sodium, phosphosoda and polyethylene glycol either alone or in combination are not sufficient in bowel preparation for visualization prior to a colonoscopy, although they are safe to use.
There is level 3 evidence (Teng et al. 2018) that bowel preparation and adenoma detection rate was similar between people with SCI and non-SCI controls undergoing colonoscopy.
There is level 4 evidence (Hayman et al. 2013) that the adequacy of bowel preparation prior to colonoscopy increased over time for Veterans with SCI, which was not associated with SCI level or completeness.
There is level 4 evidence (Song et al. 2018) that a multi-day inpatient bowel preparation is tolerable and safe for people with SCI prior to colonoscopy.
