A pilot study for using high-volume colon irrigation bowel preparation for colon capsule endoscopy shows feasibility of adequate bowel prep with high patient satisfaction

A feasibility study was performed to test a bowel preparation (BP) method that would improve patients’ experience of colon capsule endoscope (CCE) while retaining clinical adequacy. Specifically, the use of high-volume colon irrigation with the Hygieacare® System, HygiPrep™, was tested in conjunction with Medtronic’s PillCam COLON 2 Capsule. This prospective, single-center, and IRB-approved study evaluated HygiPrep use prior to the PillCam COLON 2 procedure instead of the standard split-polyethylene glycol-electrolyte (PEG) oral prep. The study was performed at Austin Gastroenterology (Austin, TX), and all capsule video files were forwarded to a Central Reader to evaluate and compile a study report. Six of the seven (86%) subjects completed both the HygiPrep and PillCam COLON 2 exams and were graded as excellent, good, or adequate by the Central Reader. Patients’ feedback reported positive satisfaction scores for both the HygiPrep and the PillCam COLON 2 procedures. These results support our hypothesis that HygiPrep was as effective as Split-PEG BP. We suggest that the HygiPrep, is a suitable BP for CCE, providing adequate BP and high patient satisfaction.

Colon Irrigation Bowel Preparation Supports Multiple Clinical Benefits in Over 8,000 Patients

This retrospective clinical study evaluates an FDA-cleared high-volume colon irrigation bowel prep (BP) for colonoscopy, performed under standard operating procedures with Austin Gastroenterology (AG, Austin, TX). Patient related outcomes in 8,364 procedures, prescribed by 33 physicians in 4.5 years, demonstrated no serious adverse events and excellent satisfaction rates. The high level of adequacy using this BP far exceeds national benchmarking thresholds for adequate colon preparations. Adequacy rates remain high even when considering poor BP risk factors and patient noncompliance with ancillary pre-preparation regimens. Our analysis demonstrates that this colon irrigation BP has excellent Boston bowel preparation scores (BBPS), associated with high-level adenoma detection rates (ADR) and sessile serrated polyp (SSP) detection rates. ADR and SSP are inversely related to the patient’s post-colonoscopy interval colorectal cancer (CRC) risk, and are similarly related to an inadequate BP. Both modeling data and performance characteristics strongly suggest that this colon irrigation BP is highly safe, effective, and will reduce the costs and risks related to inadequate BP. This, accordingly, leads to significantly improved quality outcomes, savings to the healthcare systems, and a reduction of the patient’s burden.

Appendicostomy Antegrade Colonic Irrigation by Electromechanical Pump, a Novel Method for Managing Fecal Incontinence, Randomized Clinical Trial

Antegrade colonic irrigation enema (ACIE) is established as an old treatment for child fecal incontinence and recently is approved as a treatment for different causes of adult fecal incontinence (cancer surgery, neurogenic bowel, spinal cord injury, sphincter trauma, etc.). Despite the benefits of emptying the large bowel and prevention of fecal incontinence or constipation, this method is time-consuming and requires thorough instruction and training. The purpose of this study was to innovate and assess novel technique to decrease time-consuming and improve performance of irrigation. We designed and electromechanical pump for colon irrigation and assessed by a randomized crossover clinical trial study, involving two-four weeks treatment phases. 30 patients have included that suffered fecal incontinence and had been managed with appendicostomy antegrade colon irrigation. The results showed that the pump decrease time and volume of irrigation compare with the traditional method. All patients had a reduction in toileting times. Traditional mean toileting time was 67 minutes, versus pump-toileting time that was 24.6 minutes (P:0.00). The volume of water was reduced in 13 patients. Mean of the volume was 1712 ml in the traditional method and 1128 ml in pump method (P:0.279). Mean Cleveland Clinic Florida Fecal Incontinence score (CCF_FIS) for the pump was 5.84 compare 6.24 for traditional method (P:0.000). Our study provides evidence for the first time that our novel method can facilitate and speed-up colon irrigation without any adverse effect on the outcome. © 2018 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2018;57(4):216-223.