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Use of Polyethylene Glycol in Whole Bowel Irrigation and Comparing of Systemic Effects with Lactated Ringer’S Solution

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Use of Polyethylene Glycol in Whole Bowel Irrigation and Comparing of Systemic Effects with Lactated Ringer’S Solution Research Article Clinics in Surgery Published: 14 Sep, 2018 Use of Polyethylene Glycol in Whole Bowel Irrigation and Comparing of Systemic Effects with Lactated Ringer’s Solution Emine Ince1* and Mehmet Emine Senocak2 1Departments of Pediatric Surgery, Başkent University, Turkey 2Departments of Pediatric Surgery, Hacettepe University, Turkey Abstract Aim: Whole Bowel Irrigation (WBI) has been used for many different purposes, especially in before large bowel surgery and colonoscopy. Some studies have reported that the lactated Ringer’s (RL) solution has choleretic effect and the Polyethylene Glycol (PEG) solution may produce liver necrosis. The aim of this study is to show the systemic effects of PEG in WBI and comparing with RL solution to determine the most reliable one. Methods: Forty patients who underwent WBI with PEG and RL were studied. Vital signs, electrolyte levels, liver function, hemorrhage parameters and blood table were checked before and after the procedure. Vomiting and unrest complaints were noted to tolerance reagent. The amount of solution, the duration and the efficacy of the procedure were identified. Results: WBI completed at the same time in PEG and RL group under-7 years old children. Patients used PEG were found to be better for patient compliance in 7 years old and over group, and time was decreased to 4 hours. The amount of solution was 3.2 ± 0.11 / L in PEG and 8.4 ± 0.02 / L in RL, significant difference (p<0.05). RL solution caused to be increased Na and Cl blood level (p<0.05) and PEG solution caused to be decreased K blood level (p<0.05). For liver functional test there were OPEN ACCESS no significantly differences between PEG and RL solutions. *Correspondence: Conclusion: Evaluating for tolerance, used amount and liver influence, PEG is more preferable Emine Ince, Departments of Pediatric solution compared with RL especially for 7 years old and over children. Surgery, Başkent University, Adana Keywords: Whole bowel irrigation; Polyethylene glycol; Ringer lactate Practice and Treatment Hospital Child Surgery Clinic, Seyhan Hospital Dam Introduction Road, 1. Durak Seyhan/Adana, Turkey, When the whole bowel irrigation is used for the first time, its actual purpose is to prevent the Tel: 90 322 4586868; Fax: 90 322 complications that may occur due to the infections that may form after colectomy with mechanical 4599197; intestinal cleansing [1]. However, today, its field of use has expanded greatly; for example, it is also E-mail: [email protected] used for the purpose of diagnosis and treatment in the evaluation of the absorption of elements, Received Date: 10 Aug 2018 DNA screening with samples taken from WBI fluids, heavy metal poisoning, drug intoxication, Accepted Date: 12 Sep 2018 etc [2-5]. Researchers have been interested in ensuring adequate bowel cleansing. For this purpose, Published Date: 14 Sep 2018 it was aimed to develop the method by finding the solutions that are the easiest, the most reliable, Citation: the shortest, have the least side effects and can be tolerated by the patient [6,7]. Therefore, the Ince E, Senocak ME. Use of method is developed by using different solutions. In one study, abundant bile duct contents were Polyethylene Glycol in Whole Bowel observed in cases with WBI with Ringer Lactate (RL) solution, and it was thought that this may be due to choleretic effect [6]. In an experimental study on rats, WBI was performed with Polyethylene Irrigation and Comparing of Systemic Glycol (PEG) and histopathological examination revealed liver necrosis and infarction [8]. In light Effects with Lactated Ringer’s Solution. of this information, in cases made with PEG with WBI, we aimed to determine the most reliable Clin Surg. 2018; 3: 2100. solution by displaying the effects of the relevant solution on the application period, biological data, Copyright © 2018 Emine Ince. This is electrolytes, blood table, liver function and comparing it with the RL solution, and to compare it an open access article distributed under with the recently used methods. the Creative Commons Attribution Materials and Methods License, which permits unrestricted use, distribution, and reproduction in In this study, WBI was performed preoperatively with PEG in 20 patients who were admitted any medium, provided the original work to our pediatric surgery department with the plan of colorectal surgery or colonoscopy. For is properly cited. comparison, 20 cases in which WBI is made with RL were evaluated and the second group was Remedy Publications LLC., | http://clinicsinsurgery.com/ 1 2018 | Volume 3 | Article 2100 Emine Ince, et al., Clinics in Surgery - Pediatric Surgery Table 1: Ottawa Colon Preparation score scale. Table 2: Diagnosis and indication distribution of WBI treated cases. Score Description Diagnosis Indication n(%) PEG RL 0 No fluid, empty Rectal bleeding Colonoscopy 11(27.2%) 7 4 1 Clean colon even without aspiration Anorectal malformation Perineoplasty 3 (7.5%) 1 2 2 Clean colon with aspiration Male pseudohermaphroditism Vaginoplasty 3 (7.5%) 2 1 3 Clean colon both with irrigation and aspiration Congenital megacolon Colostomy closure 8(20%) 3 5 4 The presence of solid feces Anorectal malformation Colostomy closure 5(%12.5) 2 3 Anterior ectopic anus ASARP 2(5%) 1 1 formed. A total of 40 cases were included in the study. The study was Posttraumatic urethral rupture Repair of urethra 2(5%) 2 - conducted in accordance with the Helsinki Declaration Principles and "informed consent" was obtained from the cases that participated Rectum carcinoma Mass Excision 2(5%) 2 - in the study. Extrophiavesicalis Bladder augmentation 1(2.5%) - 1 Two methods used for mechanical cleansing were recorded, Intestinal obstruction Colostomy closure 1(2.5%) - 1 taking vomiting and restlessness into consideration in order to Esophagus Stricture Colon Interposition 2(5%) - 2 determine case tolerance. Body Weight (BW) before and after the Total 40(100%) 20 20 procedure, Hour (h), Respiratory Rate (RR), Pulse (P) and Blood Pressure (BP) measurements were performed to evaluate vital signs Statistical Evaluations during the procedure. The levels of Na and K, Cl and Ca before and after the operation were checked to determine the effect of the In our study, the statistical evaluation of the findings was solutions on the electrolyte levels, as it was stated in the investigations performed with T-test (parametric test), paired test, unpaired test, that the solutions cause Na and water loss. Total Protein (Tpro), One-sample Kolmogrov-Simirnov test (one-way test), Independent Albumin (Alb), AST, ALT and GGT levels were also checked before sample test (normal distribution fit test between independent groups), and after the procedure to investigate the effects on liver function. For Chi-Square Test. When p<0.05, the data were considered significant. this, a blood sample was taken to 2 ml of the flat tube. To determine Results the effect of the solution on hemorrhage parameters, aPTT, pTINR pre-and post-procedure 3 ml blood was taken to the 9NC tube. In Twenty patients who underwent WBI were treated with PEG and order to determine its effects on hematological values; 1 ml blood was 20 patients with RL. 16 (40%) of the 40 cases who were included in taken to Sodium Ethylenediamine Tetra Acetic Acid (EDTA) tube for the study were female and 24 of them (60%) were male. Their age the control of Hemoglobin (Hb), White Blood Cell (WB), Hematocrit distributions were between 4-14 years (11.07 ± 5.6 y) for those who (Hct), Trombosit (Plt) levels. got WBI with PEG, and those who got WBI with RL were between 2-18 years (10.08 ± 25.2 y). The PEG solution used in WBI contains 125 mEq/L Na, 35 mEq/ LCl, 10 mEq/LK, 20 mEq/L bicarbonate (HCO3) and 80 mmol/L Diagnosis and indication distribution of cases; 11 cases (27.5%) PEG. The osmolarity is 263 mOsm/kg. RL solution contains 130 to investigate the etiology of rectal hemorrhage planned to undergo mEq/L Na, 109 mEq/LCl, 4 mEq/LK, 3 mEq/L Ca, 28 mEq/L lactate. colonoscopy, 3(7.5%) cases with diagnosis of opere anorectal The osmolarity is 254 mOsm/kg. malformation planned to perineoplasty , 3 cases (7.5%) with diagnosis of opere male pseudohermaphrodites planned for vaginoplasty, The Implementation of the Solution 8(20%) cases diagnosed with opere congenital megacolon planned to close the colostomy, 5 cases (12,5%) diagnosed with rectal anorectal 25 to 30 ml/kg PEG solution was orally administered to twenty malformation planned for colostomy, 2(5%) cases diagnosed with patients under nursing supervision. Based on the patient's adaptation, anterior ectopic anus for planned Anterior Sagittal Anorectoplasty Nasogastric (NG) catheter was administered to the cases who have (ASARP), 2(5%) cases diagnosed with rectal cancer planned for restlessness, vomiting and unwillingness to drink the solution and mass excision, 2(5%) cases diagnosed with posttraumatic urethral they were given 150 ml to 200 ml of solution in 15 minutes (min) of rupture planned for repair of the urethra, 1 case (2.5%) diagnosed intervals. When the contents of the intestines were clean, the process with opereextroflexvesica planned for bladder augmentation, 1(2.5%) was terminated. The process time and the amount of solution used case diagnosed with opere intestinal obstruction planned to close were noted. The patient's compliance period has been added to the colostomy, 2(5%) cases with diagnosis of developed stricture after duration of the procedure. Metoclopramide HCl 0.1 mg/kg was corrosive substance ingestion in esophagus planned for colonic administered to 20 patients 30 minutes before the procedure who interposition (Table 2). underwent WBI with RL solution. The NG probe was attached. Bowel irrigation was performed with 90 ml/kg/s RL. When the bowel Body weight, BP, P and RR (Table 3) were measured before and contents were clean, the process was terminated, and the amount of after the procedure and evaluated in cases which are applied WBI the used solution was determined and recorded.
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