Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 14, Number 5, October 2021, pages 296-303

Ischemic Colitis Caused by Bowel Preparation for Colonoscopy

Figure 1. Endoscopic findings of ischemic colitis after taking bowel preparation drugs. (a) Segmental edematous and fragile mucosa. (b) Longitudinal ulcerations.

**Table 1.** Patient Characteristics
Preparation method	Overall (n = 14,924)	“Normal”^a (n = 13,727)	“Strong”^b (n = 1,197)
^a“Normal”: taking magnesium citrate the night before colonoscopy. ^b“Strong”: taking sodium picosulfate hydrate in addition to magnesium citrate the night before colonoscopy. y.o.: years old; PEG-ELS: polyethylene glycol electrolyte solution; NaP: sodium phosphate; FIT: fecal immunochemistry test.
Age, n (%)
40 - 49 y.o.	1,700 (11.4)	1,580 (11.5)	120 (10.0)
50 - 59 y.o.	2,775 (18.6)	2,566 (18.7)	209 (17.5)
60 - 69 y.o.	4,678 (31.3)	4,352 (31.7)	326 (27.2)
70 - 79 y.o.	4,686 (31.4)	4,269 (31.1)	417 (34.8)
≥ 80 y.o.	1,085 (7.3)	960 (7.0)	125 (10.4)
Old age or not, n (%)
< 74 y.o.	11,765 (78.8)	10,895 (79.4)	870 (72.7)
≥ 75 y.o.	3,159 (21.2)	2,832 (20.6)	327 (27.3)
Sex, n (%)
Female	6,585 (44.1)	5,920 (43.1)	665 (55.6)
Male	8,339 (55.9)	7,807 (56.9)	532 (44.4)
Bowel preparation drugs in the morning of colonoscopy, n (%)
PEG-ELS	14,803 (99.2)	13,629 (99.3)	1,174 (98.1)
NaP	121 (0.8)	98 (0.7)	23 (1.9)
Indications of colonoscopy, n (%)
Surveillance	5,451 (36.5)	5,014 (36.5)	437 (36.5)
FIT positive	3,960 (26.5)	3,641 (26.5)	319 (26.6)
Screening	2,447 (16.4)	2,279 (16.6)	168 (14.0)
Mild abdominal symptom	1,354 (9.1)	1,190 (8.7)	164 (13.7)
Detailed examination	296 (2.0)	279 (2.0)	17 (1.4)
Polyp removal	86 (0.6)	82 (0.6)	4 (0.3)
Positive tumor markers	49 (0.3)	46 (0.3)	3 (0.3)
Anemia	25 (0.2)	22 (0.2)	3 (0.3)
Unknown	1,256 (8.4)	1,174 (8.6)	82 (6.9)

Table 1. Patient Characteristics

Preparation method

Overall (n = 14,924)

“Normal”^a (n = 13,727)

“Strong”^b (n = 1,197)

^a“Normal”: taking magnesium citrate the night before colonoscopy. ^b“Strong”: taking sodium picosulfate hydrate in addition to magnesium citrate the night before colonoscopy. y.o.: years old; PEG-ELS: polyethylene glycol electrolyte solution; NaP: sodium phosphate; FIT: fecal immunochemistry test.

Age, n (%)

40 - 49 y.o.

1,700 (11.4)

1,580 (11.5)

120 (10.0)

50 - 59 y.o.

2,775 (18.6)

2,566 (18.7)

209 (17.5)

60 - 69 y.o.

4,678 (31.3)

4,352 (31.7)

326 (27.2)

70 - 79 y.o.

4,686 (31.4)

4,269 (31.1)

417 (34.8)

≥ 80 y.o.

1,085 (7.3)

960 (7.0)

125 (10.4)

Old age or not, n (%)

< 74 y.o.

11,765 (78.8)

10,895 (79.4)

870 (72.7)

≥ 75 y.o.

3,159 (21.2)

2,832 (20.6)

327 (27.3)

Sex, n (%)

Female

6,585 (44.1)

5,920 (43.1)

665 (55.6)

Male

8,339 (55.9)

7,807 (56.9)

532 (44.4)

Bowel preparation drugs in the morning of colonoscopy, n (%)

PEG-ELS

14,803 (99.2)

13,629 (99.3)

1,174 (98.1)

NaP

121 (0.8)

98 (0.7)

23 (1.9)

Indications of colonoscopy, n (%)

Surveillance

5,451 (36.5)

5,014 (36.5)

437 (36.5)

FIT positive

3,960 (26.5)

3,641 (26.5)

319 (26.6)

Screening

2,447 (16.4)

2,279 (16.6)

168 (14.0)

Mild abdominal symptom

1,354 (9.1)

1,190 (8.7)

164 (13.7)

Detailed examination

296 (2.0)

279 (2.0)

17 (1.4)

Polyp removal

86 (0.6)

82 (0.6)

4 (0.3)

Positive tumor markers

49 (0.3)

46 (0.3)

3 (0.3)

Anemia

25 (0.2)

22 (0.2)

3 (0.3)

Unknown

1,256 (8.4)

1,174 (8.6)

82 (6.9)

**Table 2.** Risk of Ischemic Colitis Using Multiple Logistic Regression Analysis
	Odds ratio (95% confidence interval)	P value
^a“Normal”: taking magnesium citrate the night before colonoscopy. ^b“Strong”: taking sodium picosulfate hydrate in addition to magnesium citrate the night before colonoscopy.
“Normal”^a method	1 (reference)
“Strong”^b method	4.27 (1.45 - 12.53)	0.008
Male	1 (reference)
Female	1.67 (0.62 - 4.53)	0.31
< 75 years old	1 (reference)
≥ 75 years old	3.64 (1.36 - 9.77)	0.01

Table 2. Risk of Ischemic Colitis Using Multiple Logistic Regression Analysis

Odds ratio (95% confidence interval)

P value

^a“Normal”: taking magnesium citrate the night before colonoscopy. ^b“Strong”: taking sodium picosulfate hydrate in addition to magnesium citrate the night before colonoscopy.

“Normal”^a method

1 (reference)

“Strong”^b method

4.27 (1.45 - 12.53)

0.008

Male

1 (reference)

Female

1.67 (0.62 - 4.53)

0.31

< 75 years old

1 (reference)

≥ 75 years old

3.64 (1.36 - 9.77)

0.01

**Table 3.** Ischemic Colitis Cases After Bowel Preparation for Colonoscopy
No	Age	Sex	Indication for colonoscopy	Preparation method	Strong abdominal pain	Site	Severity^c	Other lesions
^a“Normal”: taking magnesium citrate the night before colonoscopy. ^b“Strong”: taking sodium picosulfate hydrate in addition to magnesium citrate the night before colonoscopy. ^cSeverity was determined using only the limited risk factors. M: male; F: female; FIT: fecal immunochemistry test; D: descending colon; S: sigmoid colon.
1	45	F	FIT positive	“Normal”^a	Yes	D	Mild	Adenoma
2	57	F	FIT positive	“Normal”^a	Unknown	D-S	Mild	Adenoma
3	64	M	Surveillance	“Normal”^a	No	S	Moderate	Adenoma
4	65	M	Surveillance	“Normal”^a	No	S	Moderate	No
5	67	F	Surveillance	“Strong”^b	Yes	S	Moderate	Adenoma
6	71	F	FIT positive	“Normal”^a	Yes	D	Mild	No
7	74	M	Surveillance	“Normal”^a	Yes	D	Moderate	No
8	75	F	Surveillance	“Strong”^b	Unknown	S	Mild	No
9	75	M	FIT positive	“Strong”^b	Yes	D	Moderate	Diverticulum
10	80	F	FIT positive	“Normal”^a	Yes	D-S	Mild	No
11	80	M	FIT positive	“Normal”^a	Unknown	S	Moderate	Diverticulum
12	81	M	Mild abdominal symptom	“Normal”^a	No	S	Moderate	Adenoma
13	82	F	FIT positive	“Strong”^b	Yes	S	Mild	No
14	84	F	FIT positive	“Normal”^a	Unknown	S	Moderate	Inflammatory polyp

Table 3. Ischemic Colitis Cases After Bowel Preparation for Colonoscopy

Age

Sex

Indication for colonoscopy

Preparation method

Strong abdominal pain

Site

Severity^c

Other lesions

^a“Normal”: taking magnesium citrate the night before colonoscopy. ^b“Strong”: taking sodium picosulfate hydrate in addition to magnesium citrate the night before colonoscopy. ^cSeverity was determined using only the limited risk factors. M: male; F: female; FIT: fecal immunochemistry test; D: descending colon; S: sigmoid colon.

FIT positive

“Normal”^a

Yes

Mild

Adenoma

FIT positive

“Normal”^a

Unknown

D-S

Mild

Adenoma

Surveillance

“Normal”^a

Moderate

Adenoma

Surveillance

“Normal”^a

Moderate

Surveillance

“Strong”^b

Yes

Moderate

Adenoma

FIT positive

“Normal”^a

Yes

Mild

Surveillance

“Normal”^a

Yes

Moderate

Surveillance

“Strong”^b

Unknown

Mild

FIT positive

“Strong”^b

Yes

Moderate

Diverticulum

FIT positive

“Normal”^a

Yes

D-S

Mild

FIT positive

“Normal”^a

Unknown

Moderate

Diverticulum

Mild abdominal symptom

“Normal”^a

Moderate

Adenoma

FIT positive

“Strong”^b

Yes

Mild

FIT positive

“Normal”^a

Unknown

Moderate

Inflammatory polyp

**Table 4.** Secondary Endpoints
Preparation method	“Normal”^a (n = 13,727)	“Strong”^b (n = 1,197)
^a“Normal”: taking magnesium citrate the night before colonoscopy. ^b“Strong”: taking sodium picosulfate hydrate in addition to magnesium citrate the night before colonoscopy.
Degree of preparation (Aronchick scale), n (%)
Excellent	6,672 (48.6)	482 (40.3)
Good	1,884 (13.7)	210 (17.5)
Fair	2,160 (15.7)	204 (17.0)
Poor/inadequate	527 (3.8)	81 (6.8)
Unknown	2,484 (18.1)	220 (18.4)
Additional saline enema, n (%)
Yes	180 (1.8)	55 (4.6)
No	8,749 (63.7)	839 (70.1)
Unknown	4,798 (35.0)	303 (25.3)

Table 4. Secondary Endpoints

Preparation method

“Normal”^a (n = 13,727)

“Strong”^b (n = 1,197)

^a“Normal”: taking magnesium citrate the night before colonoscopy. ^b“Strong”: taking sodium picosulfate hydrate in addition to magnesium citrate the night before colonoscopy.

Degree of preparation (Aronchick scale), n (%)

Excellent

6,672 (48.6)

482 (40.3)

Good

1,884 (13.7)

210 (17.5)

Fair

2,160 (15.7)

204 (17.0)

Poor/inadequate

527 (3.8)

81 (6.8)

Unknown

2,484 (18.1)

220 (18.4)

Additional saline enema, n (%)

Yes

180 (1.8)

55 (4.6)

8,749 (63.7)

839 (70.1)

Unknown

4,798 (35.0)

303 (25.3)