Introduction: Tablet preparation for colonoscopy has been a major advance and has been widely adopted. Performance of endoscopy at the same time as screening or surveillance colonoscopy is convenient for patients and commonly performed. Soon after adopting standard SUTAB preparation (sodium sulfate, magnesium sulfate, potassium chloride), an increase in acute hemorrhagic erosive gastropathy was observed. This case review was performed to assess the frequency of these findings after tablet versus standard prep in a single provider’s experience.
Methods: Retrospective review was made of 27 consecutive patients undergoing esophagogastroduodenoscopy and colonoscopy (EGD/ COL) after SUTAB bowel prep, group A, compared with 27 consecutive patients undergoing EGD/ COL after alternate preps, group B (suprep 22 ; miralax/ dulcolax 2 ; Plenvu 3).
Results: In group A, (sutab prep), 16 of 27 (60%) had significant mucosal findings: Erosions: 12 ; Friability: 3 ; Stigmata hemorrhage: 2. The most severe endoscopic changes were present in the antrum. In group B (liquid preps),4 of 27 (15%) had significant mucosal findings: Erosions: 4 ; Friability: 0; Stigmata hemorrhage 0. The changes were milder and less extensive than in group A.
Discussion: Acute hemorrhagic erosive gastropathy was seen in 60% of patients taking tablet prep as vs 15% taking alternate, liquid bowel preparations. The endoscopic changes were often dramatic, severe, and clearly have the ability to confound the interpretation of endoscopic findings. Further studies are needed to confirm this association, assess if similar changes are present in the esophagus, duodenum or more distal small bowel, and guide choice of bowel preparation. Based on the preliminary observations described, if indication for upper endoscopy is evaluation for gastric mucosal pathology, at this time, it seems prudent to use a non- tablet bowel preparation.
