Academic Medical Centre, University of Amsterdam, Netherlands.
Curr Med Res Opin. 2013 Aug;29(8):931-45. doi: 10.1185/03007995.2013.803055. Epub 2013 Jun 4.
Adequate bowel preparation prior to colonic diagnostic procedures is essential to ensure adequate visualisation.
This consensus aims to provide guidance as to the appropriate use of bowel preparation for a range of defined clinical circumstances. A consensus group from across Europe was convened and met to discuss appropriate bowel preparation. The use of polyethylene glycol (PEG), sodium picosulphate and sodium phosphate (NaP), together with other agents, prokinetics and simethicone, in colonoscopy and small bowel video capsule endoscopy were considered. A systematic review of the literature was carried out and additional unpublished data was obtained from the members of the consensus group where required. Recommendations were graded according to the level of evidence.
PEG-based regimens are recommended first line for both procedures, since their use is supported by good efficacy and safety data. Sodium-picosulphate-based regimens are recommended second line as their cleansing efficacy appears less than PEG-based regimens. NaP is not recommended for bowel cleansing due to the potential for renal damage and other adverse events. However, the use of NaP is acceptable in patients in whom PEG or sodium picosulphate is ineffective or not tolerated. NaP should not be used in patients with chronic kidney disease, pre-existing electrolyte disturbances, congestive heart failure, cirrhosis or a history of hypertension. The timing of the dose, dietary restrictions, use in special patient groups and recording of the quality of bowel preparation are also considered for patients undergoing colonoscopy. During the development of the guidelines the European Society of Gastrointestinal Endoscopy (ESGE) issued guidance on bowel preparation for colonoscopy. The ESGE guidelines and these consensus guidelines share many recommendations; differences between the guidelines are reviewed.
The use of bowel preparation should be tailored to the individual patient and their specific clinical circumstances.
在进行结肠诊断程序之前，充分的肠道准备对于确保充分的可视化至关重要。
本共识旨在为一系列明确的临床情况提供适当的肠道准备指导。一个来自欧洲各地的共识小组被召集并开会讨论适当的肠道准备。考虑了聚乙二醇（PEG）、枸橼酸钠（NaP）和磷酸钠（NaP）以及其他药物、促动力药和二甲硅油在结肠镜检查和小肠视频胶囊内镜检查中的应用。对文献进行了系统回顾，并根据需要从共识小组成员那里获得了额外的未发表数据。建议根据证据水平进行分级。
PEG 为基础的方案被推荐为这两种程序的一线方案，因为它们的使用得到了良好的疗效和安全性数据的支持。枸橼酸钠为基础的方案被推荐为二线方案，因为它们的清洁效果似乎不如 PEG 为基础的方案。由于可能会造成肾损伤和其他不良反应，不建议使用 NaP 进行肠道清洁。但是，在 PEG 或枸橼酸钠无效或不能耐受的患者中，可以使用 NaP。NaP 不应在患有慢性肾脏病、先前存在电解质紊乱、充血性心力衰竭、肝硬化或高血压病史的患者中使用。还考虑了结肠镜检查患者的剂量时间、饮食限制、特殊患者群体中的使用以及肠道准备质量的记录。在指南制定过程中，欧洲胃肠道内镜学会（ESGE）发布了结肠镜检查肠道准备的指南。ESGE 指南和这些共识指南有许多共同的建议；对指南之间的差异进行了审查。
肠道准备的使用应根据个体患者及其特定的临床情况进行调整。
