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• W2997647542 abstract "Ileocolonoscopy (IC) is the usual procedure in cases of acute lower GI bleeding (LGIB). It should be performed within 8 to 24 hours of a patient’s presentation after adequate colon cleansing to improve its diagnostic and therapeutic yield, which can range from 48% to 90%.1Strate L.L. Gralnek I.M. Management of patients with acute lower gastrointestinal bleeding.Am J Gastroenterol. 2016; 111: 459-474Crossref PubMed Scopus (183) Google Scholar According to American guidelines, 4 to 6 liters of polyethylene glycol (PEG)-based iso-osmolar solution should be rapidly administered over 3 to 4 hours until rectal effluent is clear; also, a nasogastric tube is used to facilitate the instillation in high-risk patients.1Strate L.L. Gralnek I.M. Management of patients with acute lower gastrointestinal bleeding.Am J Gastroenterol. 2016; 111: 459-474Crossref PubMed Scopus (183) Google Scholar However, the high volume delays the procedure, and it is poorly acceptable to patients. Recently, a very-low-volume hyperosmolar bowel preparation, based on a combination of ascorbate with 1 L PEG (PEG-Asc), has been validated in randomized trials, showing superiority compared with 2 L PEG-Asc, trisulfate, and sodium picosulfate with magnesium citrate.2DeMicco M.P. Clayton L.B. Pilot J. et al.Novel 1 L polyethylene glycol-based bowel preparation NER1006 for overall and right-sided colon cleansing: a randomized controlled phase 3 trial versus trisulfate.Gastrointest Endosc. 2018; 87: 677-687Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 3Bisschopps R. Manning J. Clayton L.B. et al.Colon cleansing efficacy and safety with 1 L NER1006 versus 2 L polyethylene glycol + ascorbate: a randomized phase 3 trial.Endoscopy. 2019; 51: 60-72Crossref Scopus (30) Google Scholar, 4Schreiber S. Baumgart D.C. Drenth J.P.H. et al.Colon cleansing efficacy and safety with 1 L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial.Endoscopy. 2019; 51: 73-84Crossref PubMed Scopus (29) Google Scholar We report the case of a 70-year-old man with a history of chronic atrial fibrillation who had been receiving ongoing anticoagulant therapy. He was hospitalized for hemorrhagic shock and severe anemia, secondary to massive LGIB. Initial resuscitation with fluids and blood transfusions was performed. Once the patient’s condition was hemodynamically stable, a nasogastric tube (to avoid the adverse event of aspiration of stomach contents in a patient with compromised mental status) was used to instill the novel 1-L PEG+Asc solution (Plenvu; Norgine, The Netherlands) and then 1 L water, in 2 hours. Urgent IC was performed 2 hours after the end of the solution intake, before the recommended 8 hours,1Strate L.L. Gralnek I.M. Management of patients with acute lower gastrointestinal bleeding.Am J Gastroenterol. 2016; 111: 459-474Crossref PubMed Scopus (183) Google Scholar with the patient in stable but critical clinical condition. The choice of a rapid hyperosmolar preparation permitted excellent bowel preparation (Boston Bowel Preparation Scale 9) but in less time, with an optimal clinical outcome. In fact, the diagnosis of oozing bleeding vessel in the cecum, type 2a Dieulafoy lesion according to the Yano-Yamamoto classification5Yano T. Yamamoto H. Sunada K. et al.Endoscopic classification of vascular lesions of the small intestine (with videos).Gastrointestinal Endosc. 2008; 67: 169-172Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar,6Reynolds J.K. Mejia V.A. Appendiceal Dieulafoy lesion: an unusual cause of massive lower gastrointestinal bleeding.Am Surg. 2015; 81: E18-E19Google Scholar (Fig. 1) was made,2DeMicco M.P. Clayton L.B. Pilot J. et al.Novel 1 L polyethylene glycol-based bowel preparation NER1006 for overall and right-sided colon cleansing: a randomized controlled phase 3 trial versus trisulfate.Gastrointest Endosc. 2018; 87: 677-687Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar,3Bisschopps R. Manning J. Clayton L.B. et al.Colon cleansing efficacy and safety with 1 L NER1006 versus 2 L polyethylene glycol + ascorbate: a randomized phase 3 trial.Endoscopy. 2019; 51: 60-72Crossref Scopus (30) Google Scholar and the lesion was successfully treated with 5 through-the-scope clips (Fig. 2; Video 1, available online at www.VideoGIE.org). Low-molecular-weight heparin was reintroduced 24 hours after the procedure. The patient was discharged home a few days later, without adverse events.Figure 2Endoscopic hemostasis with through-the-scope clip.View Large Image Figure ViewerDownload Hi-res image Download (PPT) In conclusion, the new 1-L PEG-Asc solution can be considered for rapid bowel preparation when IC has to be rapidly planned in a critical patient with severe acute LGIB. The 1-L regimen preserves similar efficacy to that of higher-volume preparations and a substantial time reduction for bowel preparation, which is clinically relevant in an urgent setting, to improve diagnostic and therapeutic IC yields. Dr Hassan is a consultant with Norgine. All other authors disclosed no financial relationships relevant to this publication. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3MzBmNGRlZDVmYmRlNzc5NjQzNTg4MWM4YWViNTlkOCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjM2ODA3NTA1fQ.NeKLJw8E3x0pMewUE-J5rwgskLGCkiomMuUksCE-1kBRbRl5k4w_wl38ye2e6uHImXxBEGfZgdmR20oMFNSsEZd7ZO_g-a1i1L3h2lNwHss8DL9khwACdFQNhwRKprnhxA3LQQwnBktuZ_zultv1g0X5fU4FUsBk1eBL-NKdaeM7KjgjqMe4kTUiAod66DaBOiX_N243oOx0xZiCVm4fpCVwutgB47WsHASHd9Asg1AqDPS1bPHSVkbzLCz5eZ_RdKiOGCEkXg158LT9s4y3r1s3ThrwV6vloFMjc0Kj_2eTMQfhHPM-uDivcwR-3XS9OAk9LEBehUhgCyDYfvfYWw Download .mp4 (37.02 MB) Help with .mp4 files Video 1Successful endoscopic procedure performed in urgent setting, within 8 hours from admission, with optimal bowel preparation." @default.
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• W2997647542 title "Efficacy of rapid bowel preparation with new 1 L polyethylene glycol ascorbate solution in severe acute lower GI bleeding" @default.
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