Colonoscopy Preparation Clinical Trial
Official title:
Adding Stewed Apricot Juice to Senna Improves the Right-Side and Overall Colon Cleansing Quality for Colonoscopy Preparation
Adequate bowel cleansing is essential for optimal colonoscopic examination. However, none of the colonoscopy preparation regimens is safe, efficient and also comfortable. The investigators' aim was to determine whether adding stewed apricot juice to senna increases patient comfort and improves bowel cleansing during colonoscopy preparation.
- Colonoscopy is the current standard method for diagnosing colon cancer and polyps, and
also can be used for therapeutic interventions such as polypectomy. Diagnostic accuracy
and therapeutic safety of the procedure depends on the quality of the colonic
cleansing. Inadequate bowel preparation may result in missed precancerous lesions,
longer colonoscopy time, lower cecal intubation rates and increased electrocautery
risks. It also causes further costs because the colonoscopy has to be re-scheduled or
alternative examinations have to be planned.
- Although polyethylene glycol (PEG) and sodium phosphate (NaP) are the main cleansing
solutions in current practice, they tend to be poorly tolerated. The need to intake a
large volume of fluid and unpleasant, salty taste of PEG reduce patient compliance. To
overcome these limitations, split-dose administration of PEG has been shown effective
and more patient-friendly. Unfortunately, PEG solutions have not been available in some
countries due to marketing problems, as in Turkey. The potential risks for clinically
significant alterations in serum electrolyte levels and hemodynamic instability in
patients with renal failure, congestive heart failure, uncontrolled hypertension and
ascites limits the usage of NaP. Moreover, European Society of Gastrointestinal
Endoscopy (ESGE) suggests that oral NaP can only be advised in selected cases such as
patients unable to tolerate other agents or only individuals to be at low risk of
NaP-related side-effects. Unfortunately, 20% of patients who consumed PEG or NaP did
not have satisfactory bowel cleansing. Because of the limitations of NaP and
unavailability of PEG solutions, senna is still the main colonoscopy preparation in
some countries..
- The ideal colonoscopy preparation would not only reliably empty the colon, but also not
cause any patient discomfort. However, none of the preparations currently meet all of
these criteria. Thus, numerous clinical trials have assessed prokinetic and spasmolytic
agents, ascorbic acid, olive oil, orange and pineapple juice to attempt to improve the
effectiveness and tolerance of colonoscopic preparation regimens. Among these
preparations, no additive effect was demonstrated for prokinetic and spasmolytic
agents, while authors determined more patient satisfaction and colon cleansing for the
rest.
- Senna alkaloids have a direct effect on intestinal mucosa, increasing the colonic
motility, enhancing colonic transit, and inhibiting water and electrolyte secretion.
Although senna were used effectively alone in the past, they have been replaced by PEG
and NaP solutions. Senna have a good-taste and are well-tolerated, inexpensive and have
fewer adverse effects, yet, their efficacy is controversial.
- Apricot (Prunus armeniaca L.) has an important place in human nutrition and can be used
as fresh or dried. Also, traditionally dried apricots have been used for many years in
Mediterranean countries as a remedy for constipation because of their high-fiber
content . Furthermore, apricots contain sorbitol (4,6g/100g) which has a laxative
effect and used for treating constipation in the elderly.
- Although these fruits are already in our life, to investigators knowledge, there is no
study examining the effects of apricot juice for precolonoscopic preparation.
Therefore, the investigators conducted this study to establish whether adding stewed
apricot juice to senna promotes bowel cleansing as well as patient comfort.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Investigator)
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