Colonoscopy outcome, safety and efficacy of colon cleansing in chronic renal failure

Abstract

SUMMARY
Objectives: We investigated the effectiveness and safety of
three different methods of colon cleansing and we also recorded
the outcome and findings of lower gastrointestinal
tract endoscopy in patients with chronic renal failure.
Methods: We prospectively collected 39 patients with chronic
renal failure The patients who were referred for endoscopy
were randomly given one of the following: For colonoscopy
(a) Method I; liquid diet for three days, enemas with sodium
phospate (Fleet) and X-Prep (senna-based laxative), and
(b) Method II; gut irrigation with a commercially available
polyethylene glycol and electrolytes solution. For sigmoidoscopy
(c) Method III; enemas with sodium phosphate
(Fleet). A gastroenterologist graded the cleanliness of the
segments of colon during endoscopy. Safety profile including
renal function and electrolytes were recorded prior to
preparation and prior to endoscopy for each patient. In
addition, patient acceptance of bowel preparation methods
(tolerance) was recorded, including any symptoms of discomfort.
Results: We found that among cleansing methods, method I
and II were equally effective. Method III had a good cleansing
effect on the rectosigmoid (10/12) but only fair cleansing
effect on the descending colon (6/12). The tolerance of
preparation was similar for all three methods. The safety profile was acceptable for all three methods. Twelve out of
39 patients had at least one positive endoscopic finding
Conclusions: Colon cleansing methods are safe for chronic
renal failure patients, provided that adequate monitoring
of electrolytes and renal function markers is available and
an experienced nephrologist is reviewing the patients
records and current condition.
Key words: colonoscopy, colon cleansing, chronic renal failure,
hemodialysis, colon preparation, continuous ambulatory
peritoneal dialysis (CAPD)