Koloskopievorbereitung bei Patienten mit Diabetes mellitus: Entwicklung einer Handlungsempfehlung

Zusammenfassung

Hintergrund Der Schlüsselfaktor für die Aussagekraft einer Koloskopie ist die Qualität der Darmvorbereitung (Kolonlavage). Eine schlechte Darmvorbereitung führt zu verlängerten Untersuchungszeiten, inkompletten Untersuchungen und erhöht das Komplikationsrisiko. Eine Diabeteserkrankung ist ein bedeutender Risikofaktor für eine insuffiziente Kolonlavage. Standardisierte Empfehlungen zur Koloskopievorbereitung von Diabetespatienten liegen bisher nicht vor.

Methode Es erfolgte eine selektive Literatursuche in PubMed und GoogleScholar bis einschließlich 06/2021. Leitlinien und Positionspapiere der deutschen, europäischen und amerikanischen Fachgesellschaften sowie klinikeigene Erfahrungen wurden ebenfalls berücksichtigt.

Ergebnisse Für die Darmvorbereitung gibt es verschiedene Wirkstoffe, die in 2 Hauptgruppen aufgeteilt werden können: Polyethylenglycol (PEG)-Lösungen und osmotische Lösungen. Es liegen inzwischen eine Reihe von Metaanalysen vor, die Unterschiede in den verschiedenen Vorbereitungsschemata untersucht haben. Die Ergebnisse sind sehr heterogen. Neben der Wahl des Abführmittels und der Frage welcher Zeitpunkt der Einnahme günstig ist, scheint die Art der Aufklärung zur Darmvorbereitung eine entscheidende Rolle zu spielen. Außerdem ist bei Diabetes-Patienten die Ernährung in den Tagen vor der Koloskopie von besonderer Bedeutung.

Schlussfolgerung PEG-basierte Abführlösungen in Split-Dosis sind bei Diabetes-Patienten aufgrund der häufig vorliegenden Motilitätsstörungen zu bevorzugen. Eine subtile Aufklärung über die Abführmaßnahmen und ein individueller Ernährungsplan für die Tage vor der Koloskopie werden empfohlen.

Abstract

Background Adequate bowel preparation prior to colonoscopy is the key factor for high quality preparation for colonoscopy. Inadequate preparation can result in prolonged procedure time, incomplete colonoscopy and an increased risk of procedural adverse events. Diabetes mellitus has been identified as a predictor of inadequate colonoscopy bowel preparation. Currently, standard recommendations for diabetes patients before colonoscopy are missing.

Methods This review is based on a selective literature search in PubMed and Google Scholar carried out in June 2021. Systematic reviews, guidelines, expert opinions, and recommendations from German and international societies were also considered.

Results The currently available preparations comprise two different groups: High-, medium- and low- volume polyethylene glycol (PEG) preparations and hyperosmotic agents. So far, a couple of reviews tried to identify outcome related differencies. Results are heterogeneous. In practise, preparation agents and timing of preparation as well as a thorough patient information before the preparation process are considered the most relevant items. In diabetes patients, preinterventional dietary recommendations are of paramount importance.

Conclusion Split dosing of PEG preparations are recommended in diabetes patients with expected motility disorders. Extensive counseling about preparation intake and dietary recommendations should be offered.

Schlüsselwörter

Koloskopie - Kolonlavage - Polyethylenglycol - Lösungen - Osmotische Lösungen - Diabetes mellitus

Keywords

colonoscopy - optimal preparation - polyethylene glycol - sodium phosphate - diabetes mellitus

Publication History

Received: 16 November 2021

Accepted after revision: 02 March 2022

Article published online:
11 May 2022

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