title: A safe and effective multi-day colonoscopy bowel preparation for individuals with spinal cord injuries.
abstract: OBJECTIVE
  Colonoscopy with polypectomy is associated with a reduced risk of colorectal cancer (CRC), but poor bowel cleansing limits the diagnostic yield of the procedure. Patients with spinal cord injury (SCI) frequently have suboptimal bowel cleansing with standard pre-colonoscopy bowel preparation regimens. We aimed to assess the safety, tolerability, and efficacy of a multi-day inpatient bowel preparation regimen in a population of patients with SCI.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  VA Puget Sound SCI Center.
  
  
  METHODS
  All patients with SCI (n = 53) who underwent inpatient colonoscopy at the VA Puget Sound from July 12, 2013 to February 12, 2015.
  
  
  METHODS
  Patient characteristics, tolerance of full bowel preparation, pre- and post-bowel preparation electrolyte values, adverse events, and adequacy of bowel cleansing were abstracted.
  
  
  RESULTS
  Sixty-eight percent of patients had a cervical level of injury and the majority were either American Spinal Injury Association Impairment Scale A (41%) or D (43%). The full bowel preparation was tolerated by 91% of inpatients. In those with pre- and post-bowel preparation laboratory testing, there were small, but statistically significant decreases in serum calcium and phosphate. No patient had symptoms associated with electrolyte abnormalities or required treatment. Five out of 53 inpatients experienced autonomic dysreflexia (AD) during bowel preparation. Eighty-nine percent of patients had adequate bowel cleansing at colonoscopy.
  
  
  CONCLUSIONS
  We demonstrate a safe and effective inpatient bowel preparation regimen in a SCI population. The regimen was associated with mild, asymptomatic hypophosphatemia and hypocalcemia. AD was an uncommon event, predominantly occurring in patients who experienced frequent AD episodes at baseline.
authors.affiliation: a Spinal Cord Injury Service , Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.|b Department of Rehabilitation Medicine , University of Washington , Seattle , Washington , USA.
authors.forename: Shawn H
authors.identifier: http://orcid.org/0000-0002-2894-7111
authors.initials: SH
authors.lastname: Song
authors.affiliation: a Spinal Cord Injury Service , Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.|b Department of Rehabilitation Medicine , University of Washington , Seattle , Washington , USA.
authors.forename: Jelena N
authors.initials: JN
authors.lastname: Svircev
authors.affiliation: c Department of Internal Medicine , University of Washington , Seattle , Washington , USA.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Teng
authors.affiliation: c Department of Internal Medicine , University of Washington , Seattle , Washington , USA.|d Division of Gastroenterology, Hospital and Specialty Medicine Service , Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Dominitz
authors.affiliation: a Spinal Cord Injury Service , Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.|b Department of Rehabilitation Medicine , University of Washington , Seattle , Washington , USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
mesh_terms: D019343:Citric Acid; D003113:Colonoscopy / Q000379:methods*; D004573:Electrolytes / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D004573:Electrolytes; D009942:Organometallic Compounds; D019343:Citric Acid; D011092:Polyethylene Glycols; C110422:magnesium citrate
keywords: Autonomic dysreflexia; Colonoscopy; Spinal cord injuries