Lim Yun Jeong, Hong Su Jin
Yun Jeong Lim, Department of Internal Medicine, College of Medicine, Dongguk University, Gyeonggi-Do 410-773, South Korea.
World J Gastroenterol. 2014 Mar 21;20(11):2741-5. doi: 10.3748/wjg.v20.i11.2741.
Adequate bowel preparation is important for successful colonoscopic examination. Several effective colonic cleansing agents are available and routinely prescribed, but each carries its own limitations and benefits from particular dosing regimens. The most frequently prescribed colonic cleansing agent, the polyethylene glycol (PEG) cathartic solution, suffers from low patient compliance in general, due to its unpalatable taste and smell coupled with the large ingested volumes required. However, PEG is preferred over other cathartics for use in individuals of advanced age, sufferers of chronic kidney disease, heart failure and inflammatory bowel disease, and women who are pregnant or lactating. The laxative agents sodium phosphate (NaP) and sodium picosulfate plus magnesium citrate have been applied and have improved patient compliance and tolerance. NaP, however, should be avoided in individuals with impaired renal function or plasma clearance, such as those with chronic kidney disease, who are taking drugs that affect renal function, or who suffer from heart failure. Other special conditions that may affect an individual's tolerance of the cathartic agent or ability to complete the administration routine include stroke, severe constipation, hematochezia, suspicious lower gastrointestinal bleeding, and mental disorders such as dementia. All ingestible bowel preparation solutions can be instilled into the stomach and duodenum through nasogastric tube or esophagogastroduodenoscope with the aid of a water irrigation pump for patients with difficulties swallowing or ingesting the large volumes of fluid required. In addition, dietary regimens based on clear liquids and low-residue foods for 1-4 d prior to the colonoscopy may be supplemental bowel preparation strategies. Achieving an effective and safe cleansing of the bowel is important for successful colonoscopy in all patients, so full knowledge of the individual's condition and capabilities is necessary to select the most appropriate colonic cleansing agent and delivery regimen.
充分的肠道准备对于成功进行结肠镜检查至关重要。有几种有效的结肠清洁剂可供常规处方使用，但每种都有其自身的局限性，并受益于特定的给药方案。最常处方的结肠清洁剂聚乙二醇（PEG）泻药溶液，总体上患者依从性较低，这是由于其味道和气味不佳，以及需要摄入大量液体。然而，对于老年人、慢性肾病患者、心力衰竭患者、炎症性肠病患者以及怀孕或哺乳期妇女，PEG比其他泻药更受青睐。磷酸钠（NaP）和比沙可啶钠加柠檬酸镁等泻药已被应用，并提高了患者的依从性和耐受性。然而，肾功能或血浆清除率受损的个体，如慢性肾病患者、正在服用影响肾功能的药物的患者或患有心力衰竭的患者，应避免使用NaP。其他可能影响个体对泻药耐受性或完成给药常规能力的特殊情况包括中风、严重便秘、便血、可疑的下消化道出血以及痴呆等精神障碍。对于吞咽或摄入大量所需液体有困难的患者，所有可口服的肠道准备溶液都可以通过鼻胃管或食管胃十二指肠镜借助水灌注泵注入胃和十二指肠。此外，在结肠镜检查前1 - 4天基于清液和低残渣食物的饮食方案可能是补充性的肠道准备策略。对于所有患者，实现有效且安全的肠道清洁对于成功进行结肠镜检查很重要，因此充分了解个体的病情和能力对于选择最合适的结肠清洁剂和给药方案是必要的。
