Advertisement

Should Oral Sodium Phosphate Solution Return as the First-Line Preparation for Colonoscopy?

Published:February 19, 2014DOI:https://doi.org/10.1016/j.cgh.2014.02.015
      Although cohort and case-control studies have shown that screening colonoscopy with polypectomy reduces colorectal cancer incidence and mortality (the latter by about 50%), gastroenterologists have been humbled to find that 1% to 9% of colon cancers represent so-called interval cancers, typically found within 3 years of a previous endoscopy.
      • Zauber A.G.
      • Winawer S.J.
      • O'Brien M.J.
      • et al.
      Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.
      • Lieberman D.
      Screening for colorectal cancer in individuals at average risk: current methods and emerging issues.
      • Cooper G.S.
      • Xu F.
      • Sloan J.S.B.
      • et al.
      Prevalence and predictors of interval colorectal cancers in Medicare beneficiaries.
      • Arain M.A.
      • Sawhney M.
      • Sheikh S.
      • et al.
      CIMP status of interval colon cancers: another piece to the puzzle.
      Interval colon cancers can result in malpractice actions against the endoscopist.
      • Rex D.K.
      Avoiding and defending malpractice suits for postcolonoscopy cancer: advice from an expert witness.
      They are much more likely to occur in the proximal colon, and many likely represent missed flat lesions. This has helped lead to one of the most important developments in gastroenterology in the past decade, namely improving the quality of screening and surveillance colonoscopy to ensure the detection and removal of all premalignant polyps, and to decrease the likelihood of developing interval cancer. Of key importance for quality colonoscopy is the necessity of careful withdrawal technique and the helpfulness of monitoring withdrawal times and adenoma detection rates. Technologic advances, such as high-definition colonoscopes, narrow-band imaging, chromoendoscopy, and colonoscopes with wider fields of view, also have helped in the detection of right-sided and flat lesions.
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zauber A.G.
        • Winawer S.J.
        • O'Brien M.J.
        • et al.
        Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.
        N Engl J Med. 2012; 366: 687-696
        • Lieberman D.
        Screening for colorectal cancer in individuals at average risk: current methods and emerging issues.
        JAMA Intern Med. 2014; 174: 10-11
        • Cooper G.S.
        • Xu F.
        • Sloan J.S.B.
        • et al.
        Prevalence and predictors of interval colorectal cancers in Medicare beneficiaries.
        Cancer. 2012; 118: 3044-3052
        • Arain M.A.
        • Sawhney M.
        • Sheikh S.
        • et al.
        CIMP status of interval colon cancers: another piece to the puzzle.
        Am J Gastroenterol. 2010; 105: 1189-1195
        • Rex D.K.
        Avoiding and defending malpractice suits for postcolonoscopy cancer: advice from an expert witness.
        Clin Gastroenterol Hepatol. 2013; 11: 768-773
      1. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.
        Gastroenterology. 2012; 143: 844-857
        • Kilgore T.W.
        • Abdinoor A.A.
        • Szary N.M.
        • et al.
        Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials.
        Gastrointest Endosc. 2011; 73: 1240-1245
        • Vanner S.J.
        • MacDonald P.H.
        • Paterson W.G.
        • et al.
        A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy.
        Am J Gastroenterol. 1990; 85: 422-427
        • Task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
        A consensus document on bowel preparation before colonoscopy.
        Gastrointest Endosc. 2006; 63: 894-909
      2. FDA News Release December 11, 2008: FDA requires new safety measures for oral sodium phosphate products to reduce risk of acute kidney injury: risk associated with both prescription and over-the-counter products. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116988.htm. Accessed January 29, 2014.

      3. FDA Alert December 11, 2008: information for healthcare professionals: oral sodium phosphate products for bowel cleansing (marketed as Visicol and OsmoPrep, and oral sodium phosphate products available without a prescription). Available at: http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm126084.htm. Accessed January 29, 2014.

        • Khurana A.
        • McLean L.
        • Atkinson S.
        • et al.
        The effect of oral sodium phosphate drug products on renal function in adults undergoing bowel endoscopy.
        Arch Intern Med. 2008; 168: 593-597
        • Ehrenpreis E.D.
        • Parakkal D.
        • Semer R.
        • et al.
        Renal risks of sodium phosphate tablets for colonoscopy preparation: a review of adverse drug reactions reported to the U.S. Food and Drug Administration.
        Colorectal Dis. 2011; 13: e270-e275
        • Brunelli S.M.
        Association between oral sodium phosphate bowel preparations and kidney injury: a systematic review and meta-analysis.
        Am J Kidney Dis. 2009; 53: 448-456
        • Layton J.B.
        • Klemmer P.J.
        • Christiansen C.F.
        • et al.
        Sodium phosphate does not increase risk for acute kidney injury after routine colonoscopy, compared with polyethylene glycol.
        Clin Gastroenterol Hepatol. 2014; 12: 1514-1521
        • Enestvedt B.K.
        • Tofani C.
        • Laine L.A.
        • et al.
        4-liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis.
        Clin Gastroenterol Hepatol. 2012; 10: 1225-1231

      Linked Article

      • Sodium Phosphate Does Not Increase Risk for Acute Kidney Injury After Routine Colonoscopy, Compared With Polyethylene Glycol
        Clinical Gastroenterology and HepatologyVol. 12Issue 9
        • Preview
          Oral sodium phosphate (OSP) is a common bowel purgative administered before colonoscopy; the Food and Drug Administration has warned against its use because of concerns about acute kidney injury (AKI) from the absorbed phosphate and dystrophic calcification. However, it is not clear if OSP is associated with AKI in the general population or in high-risk subgroups undergoing colonoscopy. We estimated the risk of AKI among patients undergoing a screening colonoscopy using OSP vs polyethylene glycol (PEG) for bowel cleansing in a large, US-based claims database.
        • Full-Text
        • PDF