Jukic Ivana, Vukovic Jonatan
Department of Gastroenterology and Hepatology, University Hospital Split, Spinciceva 1, 21000 Split, Croatia.
University Department of Health Studie, University of Split, 21000 Split, Croatia.
J Clin Med. 2025 May 11;14(10):3336. doi: 10.3390/jcm14103336.
Colonoscopy is an essential diagnostic and therapeutic tool in gastroenterology, significantly impacting colorectal cancer (CRC) detection and management. Effective bowel preparation is critical for optimal visualization, directly influencing colonoscopy accuracy and patient outcomes. However, diabetic patients frequently encounter challenges achieving adequate bowel preparation, primarily due to gastroparesis, autonomic neuropathy, altered colonic motility, fluid-electrolyte imbalances, and complexities related to antihyperglycemic medication adjustments. This review aims to evaluate the current literature on bowel preparation efficacy in diabetic patients undergoing colonoscopy, assess existing guidelines from leading gastroenterological societies, and highlight the necessity for detailed, diabetes-specific recommendations. We conducted a comprehensive PubMed search identifying 20 pertinent studies, including randomized controlled trials, meta-analyses, multicenter studies, cohort studies, and reviews. The findings consistently indicate diabetes as an independent predictor of inadequate bowel preparation. Furthermore, an evaluation of guidelines from the European Society of Gastrointestinal Endoscopy (ESGE), the US Multi-Society Task Force, and the Canadian Association of Gastroenterology revealed either absent or insufficiently detailed diabetes-specific recommendations. Given the rising global prevalence of diabetes and CRC, inadequate bowel preparation significantly impacts the quality of colonoscopy, adenoma detection rates, patient safety, and healthcare costs. This review underscores the urgent need for additional research focusing on tailored bowel preparation strategies for diabetic patients. Ultimately, the implementation of standardized, evidence-based protocols designed explicitly for this high-risk group is essential to enhance diagnostic efficacy, improve patient outcomes, and reduce CRC-related morbidity and mortality.
结肠镜检查是胃肠病学中一项重要的诊断和治疗工具，对结直肠癌（CRC）的检测和管理有重大影响。有效的肠道准备对于实现最佳视野至关重要，直接影响结肠镜检查的准确性和患者预后。然而，糖尿病患者在实现充分的肠道准备方面经常遇到挑战，主要原因是胃轻瘫、自主神经病变、结肠动力改变、水电解质失衡以及与降糖药物调整相关的复杂性。本综述旨在评估目前关于接受结肠镜检查的糖尿病患者肠道准备效果的文献，评估主要胃肠病学会的现有指南，并强调制定详细的、针对糖尿病的建议的必要性。我们在PubMed上进行了全面检索，确定了20项相关研究，包括随机对照试验、荟萃分析、多中心研究、队列研究和综述。研究结果一致表明，糖尿病是肠道准备不充分的独立预测因素。此外，对欧洲胃肠内镜学会（ESGE）、美国多学会工作组和加拿大胃肠病协会的指南进行评估发现，要么没有针对糖尿病的建议，要么建议不够详细。鉴于全球糖尿病和CRC的患病率不断上升，肠道准备不充分会显著影响结肠镜检查的质量、腺瘤检出率、患者安全和医疗成本。本综述强调迫切需要开展更多研究，聚焦于为糖尿病患者量身定制的肠道准备策略。最终，实施专门为这一高危人群设计的标准化、循证方案对于提高诊断效能、改善患者预后以及降低与CRC相关的发病率和死亡率至关重要。
