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DOI: 10.1055/s-2007-966199
© Georg Thieme Verlag KG Stuttgart · New York
Sorbitol can be the cause of colonic explosion
Publication History
Publication Date:
26 March 2007 (online)
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Endoscopy 2006; 38: 943 - 944
I read the article by Josemanders et al., ”Colonic explosion during endoscopic polypectomy: avoidable complication or bad luck?” with great interest [1]. They concluded that ”the occurrence of intracolonic gas explosion during polypectomy is, practically, an unavoidable complication.” However, the cleansing solution that they used in their patient contained sorbitol, which I believe can yield products that are combustible after bacterial fermentation. Generally, explosion is a rare event during electrocautery treatment in the colon. The cause of the explosion is ignition of gas containing hydrogen (at concentrations greater than 4 %) or methane (at concentrations greater than 5 %), and oxygen [2].
To date, there have been a few reports of colonic explosions occurring during electrocautery treatment as a result of ignition of gas produced by bacterial fermentation of nutrients and cleansing solution, especially mannitol [3] [4]. The ideal solutions for use in colonoscopy should therefore be designed to clear the colon without providing any substrate for fermentation reactions. Sorbitol is one of the sugar alcohols that can be fermented by several organisms. When the reaction takes place in a low-oxygen environment, especially in the colon, sorbitol fermentation can produce large amounts of ethanol, formate, and acetate [5] [6]. Moreover, in special circumstances, hydrogen gas can then be released from formate by formate-hydrogen lyase system activation [7]. It is speculated that hydrogen and ethanol might have been the fuel for the explosion in their case report.
My suggestion for avoiding this complication and reducing the chance of ”bad luck” during electrocautery treatment of the colon is to avoid bowel preparation regimens that contain any kind of sugar compounds, especially mannitol and sorbitol.
Competing interests: None