CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(07): E971-E977
DOI: 10.1055/a-1858-3728
Original article

Bowel preparation prior to colonoscopy with a new colonic irrigation device: Results of a prospective observational study

Niels Teich
1   Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig und Schkeuditz, Germany
Chris Klecker
1   Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig und Schkeuditz, Germany
Tobias Klugmann
1   Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig und Schkeuditz, Germany
Peter Dietel
1   Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig und Schkeuditz, Germany
› Author Affiliations
Supported by: Herrmann Apparatebau GmbH

TRIAL REGISTRATION: prospective trial at


Background and study aims The success of colonoscopy is mainly dependent on the effectiveness of prior bowel preparation (BP). Patients often consider BP to be the most burdensome part of colonoscopy, which might be a main barrier to the procedure. The aim of this study was to evaluate safety and effectiveness of colonic irrigation with a new colon hydrotherapy (CHT) device as an alternative to traditional oral BP.

Patients and methods A prospective, non-randomized observational study was conducted to evaluate the quality of BP. A BP was considered effective if a score of 6 or better through the Boston Bowel Preparation Scale (BBPS) could be reached. Colonoscopy was performed immediately following colonic irrigation. For safety analysis, data on adverse events (AEs) were collected. Among the secondary outcomes, the BBPS assessed in each bowel segment and cecal intubation rate were analyzed.

Results Twenty-eight consecutive patients (11 male [39.3%] and 17 [60.7 %] female) undergoing screening/surveillance or diagnostic colonoscopy were enrolled. Mean age was 54 ± 12.4 years (range 19–80). The evaluated mean BBPS was 7.8 ± 1.5. Twenty-five patients (89.3 %) had a BBPS score of 6 or above. Colonic irrigation was performed without any complications and no AEs were reported within 30 days. The cecal intubation rate was 100 %.

Conclusions Colonic irrigation with a new CHT device is an effective and low-risk alternative to traditional oral preparation prior to colonoscopy.

Publication History

Received: 04 November 2021

Accepted after revision: 03 May 2022

Article published online:
15 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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  • References

  • 1 Hassan C, Bretthauer M, Kaminski MF. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 142-150
  • 2 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
  • 3 Kastenberg D, Bertiger G, Brogadir S. et al. Bowel preparation quality scales for colonoscopy. World J Gastroenterol 2018; 24: 2833-2843
  • 4 Kluge MA, Williams JL, Wu CK. et al. Inadequate Boston Bowel Preparation Scale scores predict the risk of missed neoplasia on the next colonoscopy. Gastrointest Endosc 2018; 87: 744-751
  • 5 Rutherford CC, Calderwood AH. Update on bowel preparation for colonoscopy. Curr Treat Options Gastroenterol 2018; 16: 165-181
  • 6 McLachlan SA, Clements A, Austoker J. Patientsʼ experiences and reported barriers to colonoscopy in the screening context--a systematic review of the literature. Patient Educ Couns 2012; 86: 137-146
  • 7 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775-794
  • 8 Fiorito JJ, Culpepper-Morgan JA, Estabrook S. et al. Hydrotherapy compared with PEG-ES lavage and aqueous sodium phosphate as bowel preparation for elective colonoscopy. Am J Gastroenterol 2006; 101: S533
  • 9 Smukalla SM, Liang PS, Khan A. et al. Colonic irrigation as a non-oral, same-day bowel preparation for colonoscopy: efficacy, safety, and patient satisfaction. Am J Gastroenterol 2017; 112: S155
  • 10 Garzia J, Attard T, Rosen J. Colonic hydrotherapy prior to colonoscopy when oral bowel preparation is inadequate – a proof of concept study. NASPGHAN Annual Meeting. J Pediatr Gastroenterol Nutr 2019; 69: S473
  • 11 Gagneja HK, Parekh PJ. HyGIeaCare preparation for colonoscopy – a technical update for success. J Gastrointest Dig Syst 2016; 6: 4
  • 12 Gagneja H, Parekh PJ, Burleson D. et al. Colon irrigation prep outcomes, one year in review: an effective, well tolerated low-risk alternative to standard oral prep. Gastrointest Endosc 2017; 85: AB250
  • 13 Sportes A, Delvaux M, Huppertz J. et al. Randomized trial comparing high volume rectal water irrigation with standard 4 L split-dose PEG preparation before colonoscopy. J Gastroenterol Digest Dis 2016; 1: 14-20
  • 14 Sperling R, Parekh PJ, Burleson DB. et al. Salvage colonic irrigation for failed oral preparation prior to colonoscopy. Gastrointest Endosc 2018; 87: AB475-AB476
  • 15 Sperling RM, Stassen W, Godell C. et al. A high-volume colonic water irrigation method for colonoscopy bowel preparation: safe, effective, and high-level patient satisfaction. Am J Gastroenterol 2020; 115: S1639
  • 16 Kaiser-Júnior RL, DE-Quadros LG, Flamini-Júnior M. et al. New bowel preparation technique for colonoscopy: clinical trial comparing Aquanet and mannitol. Arq Bras Cir Dig 2018; 31: e1393
  • 17 Kaiser Junior RL, de Quadros LG, Faria MAG. et al. Aquanet bowel cleansing device versus oral sodium picosulfate for pre-endoscopy bowel preparation: propensity score analysis for interventional effectiveness evaluation. Gastroenterol Res 2018; 11: 18-24
  • 18 Parekh PJ, Oldfield 4th EC, Johnson DA. Bowel Preparation for Colonoscopy. In: Chandrasekhara V, Khashab M, Elmunzer BJ, Muthusamy VR. (ed.) Clinical Gastrointestinal Endoscopy. Amsterdam: Elsevier; 2019: 102-109
  • 19 Gagneja H, Parekh P, Burleson D. et al. Evaluation of Dulcolax versus magnesium citrate in preparation for colon irrigation prior to colonoscopy. Am J Gastroenterol 2017; 112: S1458-S1459
  • 20 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
  • 21 Martel M, Rostom A. et al. Validated scales for colon cleansing: a systematic review. Am J Gastroenterol 2016; 111: 197-204
  • 22 von Elm E, Altman DG, Egger M. et al. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344-349
  • 23 Sharma P, Burke CA, Johnson DA. et al. The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention. Endosc Int Open 2020; 8: E673-E683
  • 24 Underwood JA, Bekal P, Levitan O. et al. Hygiacare prep for colonoscopy consistently provides 97% adequacy, and is agnostic to poor oral bowel prep. Gastrointest Endosc 2020; 91: AB573-AB574
  • 25 Yaylali O, Kirac S, Yilmaz M. et al. Does hypothyroidism affect gastrointestinal motility?. Gastroenterol Res Pract 2009; 2009: 529802
  • 26 Johnson DA, Barkun AN, Cohen LB. et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2014; 109: 1528-1545
  • 27 Bor R, Matuz M, Fabian A. et al. Efficacy, tolerability and safety of split-dose bowel cleansing regimen of magnesium citrate with sodium picosulfate – a phase IV clinical observational study. Rev Esp Enferm Dig 2021; 113: 635-642
  • 28 Bisschops R, Manning J, Clayton LB. MORA Study Group. et al. Colon cleansing efficacy and safety with 1 L NER1006 versus 2 L polyethylene glycol + ascorbate: a randomized phase 3 trial. Endoscopy 2019; 51: 60-72
  • 29 Manes G, Repici A, Hassan C. MAGIC-P study group. Randomized controlled trial comparing efficacy and acceptability of split- and standard-dose sodium picosulfate plus magnesium citrate for bowel cleansing prior to colonoscopy. Endoscopy 2014; 46: 662-669
  • 30 Milluzzo SM, Catino F, Piccirelli S. et al. Factors associated with adequate bowel preparation: observations from the European Colonoscopy Quality Investigation questionnaire. Digest Liver Dis 2020; 52: S15
  • 31 Haibin Z, Xiaofeng Z, Jianfeng Y. Correlation of cleanliness among different bowel segments during colonoscopy: a retrospective study. Gastroenterol Res Pract 2020; 2020: 5363827
  • 32 Godell C, Frachtman R, Peake C. et al. Colon irrigation bowel preparation supports multiple clinical benefits in over 8,000 patients. Open J Gastroenterol Hepatol 2021; 4: 48